1841237526 NPI number — SRINIVAS DUVVURI MD

Table of content: SRINIVAS DUVVURI MD (NPI 1841237526)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841237526 NPI number — SRINIVAS DUVVURI MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DUVVURI
Provider First Name:
SRINIVAS
Provider Middle Name:
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:
1841237526
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/20/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11 RALPH PLACE
Provider Second Line Business Mailing Address:
SUITE 109
Provider Business Mailing Address City Name:
STATEN ISLAND
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10304-4419
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-981-2684
Provider Business Mailing Address Fax Number:
718-981-5003

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11 RALPH PLACE
Provider Second Line Business Practice Location Address:
SUITE 109
Provider Business Practice Location Address City Name:
STATEN ISLAND
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10304-4419
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-981-2684
Provider Business Practice Location Address Fax Number:
718-981-5003
Provider Enumeration Date:
06/01/2006

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: 207RI0011X , with the licence number:  192451 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207RC0000X , with the licence number: 192451 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 01001582 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4637405 . This is a "AETNA/US HEALTHCARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 10219P . This is a "HIP HEALTHCARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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