Provider Demographics
NPI:1417986167
Name:VASIREDDI, SRINIVAS S (MD)
Entity Type:Individual
Prefix:
First Name:SRINIVAS
Middle Name:S
Last Name:VASIREDDI
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 1:205 BRIDGE ST
Mailing Address - Street 2:BLDG D
Mailing Address - City:METUCHEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08840-2290
Mailing Address - Country:US
Mailing Address - Phone:732-200-3535
Mailing Address - Fax:732-444-3611
Practice Address - Street 1:205 BRIDGE ST
Practice Address - Street 2:
Practice Address - City:METUCHEN
Practice Address - State:NJ
Practice Address - Zip Code:08840-2290
Practice Address - Country:US
Practice Address - Phone:732-888-4800
Practice Address - Fax:732-444-3611
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-02
Last Update Date:2019-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06689300207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7482507Medicaid
NJ004583U73Medicare ID - Type UnspecifiedMEDICARE ID#
NJG62485Medicare UPIN