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NPI Code Detail

MEDICARE: SISIRA SRISUTIVA MD

MEDICARE: SISIRA SRISUTIVA 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
1207V00000XObstetrics & Gynecology PhysicianD0101227MD

General Provider Information

NPI Number : 1245850312
Entity Type Code : Individual
Provider Name (Legal Business Name) : SISIRA SRISUTIVA MD
Provider Business Mailing Address
First Line : 10710 CHARTER DR STE 200
Second Line :
City : COLUMBIA
State : MD
Zip : 21044-3259
Country : US
Telephone Number : 443-367-4700
Fax Number :
Provider Business Practice Location Address
First Line : 10710 CHARTER DR STE 200
Second Line :
City : COLUMBIA
State : MD
Zip : 21044-3259
Country : US
Telephone Number : 443-367-4700
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/19/2020
Last Update Date : 07/18/2024

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Directions to “ SISIRA SRISUTIVA MD” Practice Location

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