Provider Demographics
NPI:1326122904
Name:NAVAL SRINIVAS, RAJIV M (MD)
Entity Type:Individual
Prefix:
First Name:RAJIV
Middle Name:M
Last Name:NAVAL SRINIVAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:65 GLENDALE DRIVE
Mailing Address - Street 2:SUITE #1, GLENDALE MEDICAL CARE
Mailing Address - City:MANCHESTER
Mailing Address - State:KY
Mailing Address - Zip Code:40962
Mailing Address - Country:US
Mailing Address - Phone:606-599-2508
Mailing Address - Fax:606-599-2507
Practice Address - Street 1:65 GLENDALE DRIVE
Practice Address - Street 2:SUITE 1
Practice Address - City:MANCHESTER
Practice Address - State:KY
Practice Address - Zip Code:40962
Practice Address - Country:US
Practice Address - Phone:606-599-2508
Practice Address - Fax:606-599-2507
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2011-03-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
173000000X
KY38046207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No173000000XOther Service ProvidersLegal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64068075Medicaid
KY64068075Medicaid
KYH81410Medicare UPIN