Provider Demographics
NPI:1043307671
Name:PRADEEP SRIVASTAVA MD PC
Entity Type:Organization
Organization Name:PRADEEP SRIVASTAVA MD PC
Other - Org Name:ADVANCE CARDIAR AND MEDICAL ASSOCIATES,PC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT CORP
Authorized Official - Prefix:DR
Authorized Official - First Name:PRADEEP
Authorized Official - Middle Name:
Authorized Official - Last Name:SRIVASTAVA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-474-9222
Mailing Address - Street 1:7227 HANOVER PKWY
Mailing Address - Street 2:# B
Mailing Address - City:GREENBELT
Mailing Address - State:MD
Mailing Address - Zip Code:20770-2025
Mailing Address - Country:US
Mailing Address - Phone:301-474-9222
Mailing Address - Fax:301-474-9225
Practice Address - Street 1:7227 HANOVER PKWY
Practice Address - Street 2:#B
Practice Address - City:GREENBELT
Practice Address - State:MD
Practice Address - Zip Code:20770-2025
Practice Address - Country:US
Practice Address - Phone:301-474-9222
Practice Address - Fax:301-474-9225
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-06
Last Update Date:2017-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD33483207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
B71148Medicare UPIN
MD001050Medicare ID - Type Unspecified
B71148Medicare UPIN