Provider Demographics
NPI:1386630572
Name:SRINIVASAN, MURALI (MD)
Entity Type:Individual
Prefix:
First Name:MURALI
Middle Name:
Last Name:SRINIVASAN
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 1:5248 ZEPHYR LN UNIT 25
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92120-2749
Mailing Address - Country:US
Mailing Address - Phone:360-441-0311
Mailing Address - Fax:
Practice Address - Street 1:5248 ZEPHYR LN UNIT 25
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92120-2749
Practice Address - Country:US
Practice Address - Phone:360-441-0311
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-22
Last Update Date:2021-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA14080R207RG0300X
WAMD00047234207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0215499OtherL&I AND CRIME VICTIMS
WA1386630572Medicaid
WA7204536OtherAETNA
WA5598SROtherREGENCE
WAP00389670OtherRAILROAD MEDICARE
110220089OtherRAILROAD MEDICARE
WA8470486Medicaid
WA5598SROtherREGENCE
4A301Medicare ID - Type Unspecified
WAG8862913Medicare PIN