Provider Demographics
NPI:1063859866
Name:SRIVASTAVA, ANJALI (MD, MBA)
Entity Type:Individual
Prefix:
First Name:ANJALI
Middle Name:
Last Name:SRIVASTAVA
Suffix:
Gender:F
Credentials:MD, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 MEDICAL CENTER BLVD
Mailing Address - Street 2:3 EAST
Mailing Address - City:CHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19013-3902
Mailing Address - Country:US
Mailing Address - Phone:610-447-6680
Mailing Address - Fax:610-447-6677
Practice Address - Street 1:1 MEDICAL CENTER BLVD
Practice Address - Street 2:CROZER PEDIATRICS, POB 1, SUITE 205
Practice Address - City:CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19013-3902
Practice Address - Country:US
Practice Address - Phone:610-619-7410
Practice Address - Fax:610-876-8483
Is Sole Proprietor?:No
Enumeration Date:2013-06-03
Last Update Date:2015-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT209522208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA22-2540851Medicaid