Provider Demographics
NPI:1073558599
Name:DORASWAMY, SRINIVAS (MD)
Entity Type:Individual
Prefix:
First Name:SRINIVAS
Middle Name:
Last Name:DORASWAMY
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 1:223 S STATE ROAD 135
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46142-1421
Mailing Address - Country:US
Mailing Address - Phone:317-881-9792
Mailing Address - Fax:317-881-9792
Practice Address - Street 1:223 S STATE ROAD 135
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46142-1421
Practice Address - Country:US
Practice Address - Phone:317-881-9792
Practice Address - Fax:317-881-9792
Is Sole Proprietor?:No
Enumeration Date:2006-06-18
Last Update Date:2013-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036114154207L00000X
IN01053184A208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200476260EMedicaid
IN200476260JMedicaid
IN200476260AMedicaid
IN200476260FMedicaid
IL036114154Medicaid
IN200476260AMedicaid
IN200476260FMedicaid
IN200476260EMedicaid