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NPI Code Detail

MEDICARE: DR. PANKAJ SRIVASTAVA MD

MEDICARE: DR. PANKAJ SRIVASTAVA 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
1207R00000XInternal Medicine PhysicianMD34709TN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1000000118807OTHERBETTER HEALTH
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
34012046OTHERBC
462-1815075OTHEROMNI

General Provider Information

NPI Number : 1487655957
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. PANKAJ SRIVASTAVA MD
Provider Business Mailing Address
First Line : 1445 US HIGHWAY 51 BYP E
Second Line :
City : DYERSBURG
State : TN
Zip : 38024-2127
Country : US
Telephone Number : 731-286-1900
Fax Number : 731-286-1939
Provider Business Practice Location Address
First Line : 1445 US HIGHWAY 51 BYP E
Second Line : SUITE C
City : DYERSBURG
State : TN
Zip : 38024-2127
Country : US
Telephone Number : 731-286-1900
Fax Number : 731-286-1939
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/09/2005
Last Update Date : 10/03/2014

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Directions to “ DR. PANKAJ SRIVASTAVA MD” Practice Location

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