MEDICARE: PATTANAM DORAI SRINIVASAN 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	208VP0014X	Interventional Pain Medicine Physician	ME124951	FL
2	207L00000X	Anesthesiology Physician	ME124951	FL

General Provider Information

NPI Number	:	1225084155
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PATTANAM DORAI SRINIVASAN M.D.

Provider Business Mailing Address
First Line	:	3740 EMBASSY CIR
Second Line	:
City	:	PALM HARBOR
State	:	FL
Zip	:	34685-1016
Country	:	US
Telephone Number	:	727-474-6507
Fax Number	:	765-450-6161

Provider Business Practice Location Address
First Line	:	4738 GRAND BLVD STE G
Second Line	:
City	:	NEW PORT RICHEY
State	:	FL
Zip	:	34652-5170
Country	:	US
Telephone Number	:	727-474-6507
Fax Number	:	765-450-6161

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

Provider Enumeration Date	:	05/25/2006
Last Update Date	:	05/07/2025

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