1669695946 NPI number — RAJAGOPAL SRINIVASAN M.D., PH.D.

Table of content: RAJAGOPAL SRINIVASAN M.D., PH.D. (NPI 1669695946)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669695946 NPI number — RAJAGOPAL SRINIVASAN M.D., PH.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SRINIVASAN
Provider First Name:
RAJAGOPAL
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D., PH.D.
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:
1669695946
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/03/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
110 S PACA ST
Provider Second Line Business Mailing Address:
DEPARTMENT OF EMERGENCY MEDICINE 6TH FLOOR SUITE 200
Provider Business Mailing Address City Name:
BALTIMORE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21201-1642
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-328-8025
Provider Business Mailing Address Fax Number:
410-328-8028

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
981150 NEBRASKA MEDICAL CTR
Provider Second Line Business Practice Location Address:
SECTION OF EMERGENCY MEDICINE ACADEMIC OFFICES
Provider Business Practice Location Address City Name:
OMAHA
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68198-1150
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
404-559-6802
Provider Business Practice Location Address Fax Number:
402-559-9659
Provider Enumeration Date:
04/11/2007

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: 207P00000X , with the licence number:  4977 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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