Provider Demographics
NPI:1033386057
Name:SRINIVASAN, SHARMILA (MD)
Entity Type:Individual
Prefix:DR
First Name:SHARMILA
Middle Name:
Last Name:SRINIVASAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 PEARL ST STE 1300
Mailing Address - Street 2:
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02301-2867
Mailing Address - Country:US
Mailing Address - Phone:508-232-3222
Mailing Address - Fax:508-510-4774
Practice Address - Street 1:1 PEARL ST STE 1300
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301-2867
Practice Address - Country:US
Practice Address - Phone:508-232-3222
Practice Address - Fax:508-510-4774
Is Sole Proprietor?:No
Enumeration Date:2008-05-08
Last Update Date:2022-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA281438207WX0107X, 207WX0107X
VA010125827207W00000X
TXN7178207W00000X
CAA110061207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1174285365OtherNPI