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NPI Code Detail

MEDICARE: DR. SRINIVAS RAO DONTINENI MD

MEDICARE: DR. SRINIVAS RAO DONTINENI 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 PhysicianME88036FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
182027OTHERFLBLUE CROSS BLUE SHIELD
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1669467155
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. SRINIVAS RAO DONTINENI MD
Provider Business Mailing Address
First Line : PO BOX 560059
Second Line :
City : ROCKLEDGE
State : FL
Zip : 32956-0059
Country : US
Telephone Number : 321-795-6380
Fax Number : 321-208-8515
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 :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/12/2005
Last Update Date : 01/28/2025

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