MEDICARE: MR. CHINAGANDHAM SRINIVISA BHUPATHI

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207X00000X	Orthopaedic Surgery Physician	116509	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1114911963
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. CHINAGANDHAM SRINIVISA BHUPATHI

Provider Business Mailing Address
First Line	:	11 RALPH PL
Second Line	:	SUITE 102
City	:	STATEN ISLAND
State	:	NY
Zip	:	10304-4419
Country	:	US
Telephone Number	:	718-447-6545
Fax Number	:	718-447-5297

Provider Business Practice Location Address
First Line	:	11 RALPH PL
Second Line	:	SUITE 102
City	:	STATEN ISLAND
State	:	NY
Zip	:	10304-4419
Country	:	US
Telephone Number	:	718-447-6545
Fax Number	:	718-447-5297

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/08/2005
Last Update Date	:	07/08/2007

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Directions to “ MR. CHINAGANDHAM SRINIVISA BHUPATHI ” Practice Location

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