Provider Demographics
NPI:1083693691
Name:SRINIVASAN, PRIYADARSHINI (MD)
Entity Type:Individual
Prefix:DR
First Name:PRIYADARSHINI
Middle Name:
Last Name:SRINIVASAN
Suffix:
Gender:F
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 844658
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-4658
Mailing Address - Country:US
Mailing Address - Phone:254-724-8800
Mailing Address - Fax:
Practice Address - Street 1:120 HILLCREST MEDICAL BLVD STE 200
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76712-8950
Practice Address - Country:US
Practice Address - Phone:254-297-0400
Practice Address - Fax:254-297-0404
Is Sole Proprietor?:No
Enumeration Date:2006-01-12
Last Update Date:2020-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC53895208000000X
TXP5477208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C538950Medicare UPIN
CACU801ZMedicare PIN