Provider Demographics
NPI:1295467983
Name:ADUSUMALLI, SRIKANTH (MBBS, FRACP)
Entity Type:Individual
Prefix:DR
First Name:SRIKANTH
Middle Name:
Last Name:ADUSUMALLI
Suffix:
Gender:M
Credentials:MBBS, FRACP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:MASS GENERAL BRIGHAM CENTRAL CREDENTIALING OFFICE
Mailing Address - Street 2:399 REVOLUTION DRIVE-STE 910
Mailing Address - City:SOMERVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02145
Mailing Address - Country:US
Mailing Address - Phone:857-282-3083
Mailing Address - Fax:
Practice Address - Street 1:MASSACHUSETTS GENERAL HOSPITAL
Practice Address - Street 2:55 FRUIT STREET
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114
Practice Address - Country:US
Practice Address - Phone:617-726-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-30
Last Update Date:2023-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA291922390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program