Provider Demographics
NPI:1124025374
Name:PATHAPATI, SRINIVAS (MD)
Entity Type:Individual
Prefix:DR
First Name:SRINIVAS
Middle Name:
Last Name:PATHAPATI
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 1:6833 PLUM CREEK DRIVE
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79124-1602
Mailing Address - Country:US
Mailing Address - Phone:806-467-9820
Mailing Address - Fax:806-467-9743
Practice Address - Street 1:6833 PLUM CREEK DR
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79124-1602
Practice Address - Country:US
Practice Address - Phone:806-467-9820
Practice Address - Fax:806-468-8340
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-01
Last Update Date:2019-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK9386207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0066QVOtherBCBS PROVIDER GRP. NO
TX160272401Medicaid
TX00568UOtherMEDICARE GROUP PIN
TX8AJ983OtherBCBS PROVIDER NO.
TX8AJ983OtherBCBS PROVIDER NO.
TXG57397Medicare UPIN