Provider Demographics
NPI:1043351091
Name:THANDLA, SRINIVAS PERUMAL (MD)
Entity Type:Individual
Prefix:
First Name:SRINIVAS
Middle Name:PERUMAL
Last Name:THANDLA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4039 ROUTE 219
Mailing Address - Street 2:SUITE 103
Mailing Address - City:SALAMANCA
Mailing Address - State:NY
Mailing Address - Zip Code:14779-9625
Mailing Address - Country:US
Mailing Address - Phone:716-945-0368
Mailing Address - Fax:
Practice Address - Street 1:4039 ROUTE 219
Practice Address - Street 2:SUITE 103
Practice Address - City:SALAMANCA
Practice Address - State:NY
Practice Address - Zip Code:14779-9625
Practice Address - Country:US
Practice Address - Phone:716-945-0368
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY237701208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics