Provider Demographics
NPI:1164673232
Name:GUNTURU, SREENIVAS DUTT (MD)
Entity Type:Individual
Prefix:
First Name:SREENIVAS
Middle Name:DUTT
Last Name:GUNTURU
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 1:1109 BROOKDALE STREET
Mailing Address - Street 2:
Mailing Address - City:MARTINSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24112
Mailing Address - Country:US
Mailing Address - Phone:276-666-7545
Mailing Address - Fax:276-632-0911
Practice Address - Street 1:1109 BROOKDALE STREET
Practice Address - Street 2:
Practice Address - City:MARTINSVILLE
Practice Address - State:VA
Practice Address - Zip Code:24112
Practice Address - Country:US
Practice Address - Phone:276-666-7545
Practice Address - Fax:276-632-0911
Is Sole Proprietor?:No
Enumeration Date:2008-10-07
Last Update Date:2011-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101248556208000000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program