MEDICARE: DR. MANOJ SRINATH MD

Medicare Provider Information

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RG0100X	Gastroenterology Physician	035088	TN
2	207RG0100X	Gastroenterology Physician	0101230824	VA
3	207RG0100X	Gastroenterology Physician	MD 35088	TN

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

NPI Number	:	1356344402
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MANOJ SRINATH MD

Provider Business Mailing Address
First Line	:	135 W RAVINE RD STE 3-A
Second Line	:
City	:	KINGSPORT
State	:	TN
Zip	:	37660-3847
Country	:	US
Telephone Number	:	423-246-6777
Fax Number	:	423-246-7766

Provider Business Practice Location Address
First Line	:	235 MEDICAL PARK BLVD
Second Line	:
City	:	BRISTOL
State	:	TN
Zip	:	37620-7455
Country	:	US
Telephone Number	:	423-274-6350
Fax Number	:	423-274-6354

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

Provider Enumeration Date	:	05/23/2005
Last Update Date	:	07/21/2022

235 MEDICAL PARK BLVD
BRISTOL, TN
37620-7455

Practice Phone: 423-878-0232
Practice Fax: 615-620-2323