1427088897 NPI number — DR. SRINIVASA RAO POTLURI MD

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427088897 NPI number — DR. SRINIVASA RAO POTLURI MD

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

POTLURI

Provider First Name:

SRINIVASA

Provider Middle Name:

RAO

Provider Name Prefix Text:

DR.

Provider Name Suffix Text:

Provider Credential Text:

MD

Provider Gender Code:

M

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:

1427088897

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

04/10/2024

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

676 US HIGHWAY 202/206

Provider Second Line Business Mailing Address:

BLDG 2

Provider Business Mailing Address City Name:

BRIDGEWATER

Provider Business Mailing Address State Name:

NJ

Provider Business Mailing Address Postal Code:

08807-1761

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

908-218-1180

Provider Business Mailing Address Fax Number:

908-218-1718

Provider First Line Business Practice Location Address:

676 US HIGHWAY 202/206

Provider Second Line Business Practice Location Address:

BLDG 2

Provider Business Practice Location Address City Name:

BRIDGEWATER

Provider Business Practice Location Address State Name:

NJ

Provider Business Practice Location Address Postal Code:

08807-1761

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

908-218-1180

Provider Business Practice Location Address Fax Number:

908-218-1718

Provider Enumeration Date:

07/03/2006

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 2084N0400X , with the licence number:  25MA07137500 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
• Taxonomy code: 2084N0600X , with the licence number: 25MA07137500 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

• Identifier: 2K4368 . This is a "HEALTHNET" identifier . This identifiers is of the category "OTHER".
• Identifier: 5148191 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
• Identifier: 8686301 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
• Identifier: 9001121440 . This is a "HORIZON BLUECROSS BLUESHI" identifier . This identifiers is of the category "OTHER".
• Identifier: 211930200 . This is a "AMERIHEALTH HMO" identifier . This identifiers is of the category "OTHER".
• Identifier: 2229034000 . This is a "AMERIHEALTH PPO" identifier . This identifiers is of the category "OTHER".
• Identifier: 3342020 . This is a "AETNA INDIVIDUAL" identifier . This identifiers is of the category "OTHER".
• Identifier: 900112144 . This is a "UNITED HEALTH CARE" identifier . This identifiers is of the category "OTHER".
• Identifier: P00091708 . This is a "MEDICARE RAILROAD" identifier . This identifiers is of the category "OTHER".
• Identifier: 90-0112144 . This is a "QUALCARE" identifier . This identifiers is of the category "OTHER".
• Identifier: P2486490 . This is a "OXFORD" identifier . This identifiers is of the category "OTHER".
• Identifier: 3342021 . This is a "AETNA GROUP ID NUMBER" identifier . This identifiers is of the category "OTHER".