1639323041 NPI number — SRINIVAS DONTINENI MD PA

Table of content: (NPI 1639323041)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639323041 NPI number — SRINIVAS DONTINENI MD PA

Organization/Personal Information

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

Provider's Other Name Information

Provider Other Organization Name:
BREVARD HOSPITALIST ASSOCIATES
Provider Other Organization Name Type Code:
3
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:
1639323041
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/02/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 560059
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROCKLEDGE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32956-0059
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
321-751-9506
Provider Business Mailing Address Fax Number:
321-751-9505

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2800 AURORA RD STE F
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MELBOURNE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32935-2015
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
321-368-3862
Provider Business Practice Location Address Fax Number:
321-208-8717
Provider Enumeration Date:
11/12/2008

Additional Information

Authorized Official

Authorized Official Last Name:
DONTINENI
Authorized Official First Name:
SRINIVAS
Authorized Official Middle Name:
RAO
Authorized Official Title or Position:
INTERNAL MEDICINE PHYSICIAN
Authorized Official Telephone Number:
321-751-9506

Provider Taxonomy Codes

  • Taxonomy code: 207RI0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: BM919A . This is a "MEDICARE PTAN" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 004793700 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com