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NPI Code Detail

MEDICARE: SRINIVAS DONTINENI MD PA

MEDICARE: SRINIVAS DONTINENI MD PA
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
1207RI0200XInfectious Disease Physician

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2BM919AOTHERFLMEDICARE PTAN

Other Identifiers

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

General Provider Information

NPI Number : 1639323041
Entity Type Code : Organization
Provider Name (Legal Business Name) : SRINIVAS DONTINENI MD PA
Provider Business Mailing Address
First Line : PO BOX 560059
Second Line :
City : ROCKLEDGE
State : FL
Zip : 32956-0059
Country : US
Telephone Number : 321-368-3862
Fax Number : 321-208-8717
Provider Business Practice Location Address
First Line : 2428 CLEARLAKE RD BLDG K
Second Line :
City : COCOA
State : FL
Zip : 32922-5722
Country : US
Telephone Number : 321-368-3862
Fax Number : 321-208-8717
Authorized Official
Title or Position : INTERNAL MEDICINE PHYSICIAN
Name : DR. SRINIVAS RAO DONTINENI
Credential : MD
Telephone Number : 321-751-9506
Provider Enumeration Date : 11/12/2008
Last Update Date : 01/28/2025

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1932983061 — TSF MEDICAL LLC
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Directions to “SRINIVAS DONTINENI MD PA ” Practice Location

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