1134102825 NPI number — SRINIVAS R MERUGU MD

Table of content: SRINIVAS R MERUGU MD (NPI 1134102825)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134102825 NPI number — SRINIVAS R MERUGU MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MERUGU
Provider First Name:
SRINIVAS
Provider Middle Name:
R
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1134102825
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/10/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 932127
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CLEVELAND
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44193-0008
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
216-472-2730
Provider Business Mailing Address Fax Number:
216-472-2740

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2475 E 22ND ST
Provider Second Line Business Practice Location Address:
SUITE 120
Provider Business Practice Location Address City Name:
CLEVELAND
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44115-3221
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
216-431-1500
Provider Business Practice Location Address Fax Number:
216-431-7701
Provider Enumeration Date:
11/28/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  35 082383 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2432255 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00050732 . This is a "RR MEDICARE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com