Provider Demographics
NPI:1407959802
Name:SRINATH, LATHA (MD)
Entity Type:Individual
Prefix:MRS
First Name:LATHA
Middle Name:
Last Name:SRINATH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2300 SOUTH CONGRESS AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33426
Mailing Address - Country:US
Mailing Address - Phone:561-735-7531
Mailing Address - Fax:561-742-8250
Practice Address - Street 1:2300 SOUTH CONGRESS AVE STE 100
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33426
Practice Address - Country:US
Practice Address - Phone:561-735-7531
Practice Address - Fax:561-742-8250
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0066586207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL376440100Medicaid
FL25857OtherBLUE CROSS
FL2198994OtherAETNA
FL376440100Medicaid
E69242Medicare UPIN