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NPI Code Detail

MEDICARE: MR. SRINIVASA SRIDHAR MD

MEDICARE: MR. SRINIVASA SRIDHAR MD
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
1207X00000XOrthopaedic Surgery PhysicianME0027133FL

General Provider Information

NPI Number : 1134112592
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. SRINIVASA SRIDHAR MD
Provider Business Mailing Address
First Line : 740 W PLYMOUTH AVE
Second Line :
City : DELAND
State : FL
Zip : 32720-3282
Country : US
Telephone Number : 386-734-9122
Fax Number :
Provider Business Practice Location Address
First Line : 740 W PLYMOUTH AVE
Second Line :
City : DELAND
State : FL
Zip : 32720-3282
Country : US
Telephone Number : 386-734-9122
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/31/2005
Last Update Date : 07/26/2024

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