Provider Demographics
NPI:1083693360
Name:SRIVASTAVA, SUNNY (MD)
Entity Type:Individual
Prefix:
First Name:SUNNY
Middle Name:
Last Name:SRIVASTAVA
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 1:1 PARKWAY
Mailing Address - Street 2:
Mailing Address - City:HAVERHILL
Mailing Address - State:MA
Mailing Address - Zip Code:01830-6278
Mailing Address - Country:US
Mailing Address - Phone:978-521-3288
Mailing Address - Fax:978-469-5644
Practice Address - Street 1:1 PARKWAY
Practice Address - Street 2:
Practice Address - City:HAVERHILL
Practice Address - State:MA
Practice Address - Zip Code:01830-6278
Practice Address - Country:US
Practice Address - Phone:978-521-3288
Practice Address - Fax:978-469-5644
Is Sole Proprietor?:No
Enumeration Date:2006-01-13
Last Update Date:2012-11-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA214243207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1083693360OtherAETNA HMO
MA110006203AMedicaid
MA25-11019OtherEVERCARE
MAJ25450OtherBLUE CROSS BLUE SHIELD
MAP00329487OtherRAILROAD MEDICARE
MA214243OtherTUFTS
683109OtherHEALTHSOURCE
5642268OtherCIGNA
NHH67327OtherANTHEM BLUE CROSS
973725OtherNETWORK HEALTH
MAAA51199OtherHARVARD PILGRIM
0027261OtherNEIGHBORHOOD HEALTH PLAN
NH30205813OtherNEW HAMPSHIRE MEDICAID
MA7930396OtherAETNA NON HMO
MA1083693360OtherFALLON COMMUNITY HEALTH PLAN
NHH67327OtherANTHEM BLUE CROSS
5642268OtherCIGNA