Provider Demographics
NPI:1073616397
Name:ATLURI, SRIDHAR (MD)
Entity Type:Individual
Prefix:
First Name:SRIDHAR
Middle Name:
Last Name:ATLURI
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:PO BOX 96
Mailing Address - Street 2:
Mailing Address - City:GLEN BURNIE
Mailing Address - State:MD
Mailing Address - Zip Code:21060-0096
Mailing Address - Country:US
Mailing Address - Phone:410-768-3936
Mailing Address - Fax:410-766-6683
Practice Address - Street 1:7310 RITCHIE HWY
Practice Address - Street 2:SUITE 800
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061-3065
Practice Address - Country:US
Practice Address - Phone:410-768-3936
Practice Address - Fax:410-766-6683
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2012-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDDOO50470207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD040N884FMedicare ID - Type Unspecified