Provider Demographics
NPI:1265500748
Name:SRIVASTAVA, PRADEEP (MD FA CC)
Entity Type:Individual
Prefix:DR
First Name:PRADEEP
Middle Name:
Last Name:SRIVASTAVA
Suffix:
Gender:M
Credentials:MD FA CC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9804 BENT CROSS ROAD
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20854
Mailing Address - Country:US
Mailing Address - Phone:301-983-3575
Mailing Address - Fax:301-983-4605
Practice Address - Street 1:7227 B HANOVER PARKWAY
Practice Address - Street 2:
Practice Address - City:GREENBELT
Practice Address - State:MD
Practice Address - Zip Code:20770
Practice Address - Country:US
Practice Address - Phone:301-474-9222
Practice Address - Fax:301-474-9225
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD33483207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
B71148Medicare UPIN
735005P50Medicare ID - Type Unspecified