MEDICARE: DR. SRINIVAS C GUMMARAJU M.D.

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	207RH0003X	Hematology & Oncology Physician	A55763	CA

General Provider Information

NPI Number	:	1154306991
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SRINIVAS C GUMMARAJU M.D.

Provider Business Mailing Address
First Line	:	1290 NORTHGATE DR
Second Line	:	APT. 53
City	:	YUBA CITY
State	:	CA
Zip	:	95991-1534
Country	:	US
Telephone Number	:	530-749-4400
Fax Number	:

Provider Business Practice Location Address
First Line	:	4501 X ST
Second Line	:	SUITE 3016
City	:	SACRAMENTO
State	:	CA
Zip	:	95817-2229
Country	:	US
Telephone Number	:	530-749-4400
Fax Number	:	530-749-4534

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

Provider Enumeration Date	:	12/14/2005
Last Update Date	:	07/08/2007

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