Provider Demographics
NPI:1003098237
Name:IVATURY, SRINIVAS J (MD)
Entity Type:Individual
Prefix:DR
First Name:SRINIVAS
Middle Name:J
Last Name:IVATURY
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1 MEDICAL CENTER DR
Mailing Address - Street 2:DEPARTMENT OF COLON & RECTAL SURGERY
Mailing Address - City:LEBANON
Mailing Address - State:NH
Mailing Address - Zip Code:03756-1000
Mailing Address - Country:US
Mailing Address - Phone:603-650-8113
Mailing Address - Fax:603-650-8030
Practice Address - Street 1:1 MEDICAL CENTER DR
Practice Address - Street 2:COLON & RECTAL SURGERY DEPARTMENT
Practice Address - City:LEBANON
Practice Address - State:NH
Practice Address - Zip Code:03756-1000
Practice Address - Country:US
Practice Address - Phone:603-650-8113
Practice Address - Fax:603-650-8030
Is Sole Proprietor?:No
Enumeration Date:2007-11-29
Last Update Date:2014-08-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
390200000X
NH16715208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program