Provider Demographics
NPI:1093078222
Name:SRIRAM, PREETHI (MD)
Entity Type:Individual
Prefix:DR
First Name:PREETHI
Middle Name:
Last Name:SRIRAM
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 1:300 HOSPITAL DR STE 121
Mailing Address - Street 2:
Mailing Address - City:GLEN BURNIE
Mailing Address - State:MD
Mailing Address - Zip Code:21061-5706
Mailing Address - Country:US
Mailing Address - Phone:410-787-4940
Mailing Address - Fax:
Practice Address - Street 1:300 HOSPITAL DR STE 121
Practice Address - Street 2:
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061-5706
Practice Address - Country:US
Practice Address - Phone:410-787-4940
Practice Address - Fax:410-787-4941
Is Sole Proprietor?:No
Enumeration Date:2012-06-21
Last Update Date:2019-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MDD83897207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program