MEDICARE: SRINIVAS ADDALA 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	207RC0000X	Cardiovascular Disease Physician	D0047943	MD

General Provider Information

NPI Number	:	1447241872
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SRINIVAS ADDALA M.D.

Provider Business Mailing Address
First Line	:	9135 PISCATAWAY RD STE 210
Second Line	:
City	:	CLINTON
State	:	MD
Zip	:	20735-2542
Country	:	US
Telephone Number	:	301-868-1380
Fax Number	:

Provider Business Practice Location Address
First Line	:	9135 PISCATAWAY RD STE 210
Second Line	:
City	:	CLINTON
State	:	MD
Zip	:	20735-2542
Country	:	US
Telephone Number	:	301-868-1380
Fax Number	:

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

Provider Enumeration Date	:	11/03/2005
Last Update Date	:	02/23/2012

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