Provider Demographics
NPI:1437343035
Name:JAIN, SIRISHA MADDIPOTI (MD)
Entity Type:Individual
Prefix:DR
First Name:SIRISHA
Middle Name:MADDIPOTI
Last Name:JAIN
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 1:2520 CHERRY AVE
Mailing Address - Street 2:
Mailing Address - City:BREMERTON
Mailing Address - State:WA
Mailing Address - Zip Code:98310-4229
Mailing Address - Country:US
Mailing Address - Phone:360-479-6154
Mailing Address - Fax:360-479-5728
Practice Address - Street 1:2720 CLARE AVE
Practice Address - Street 2:SUITE A
Practice Address - City:BREMERTON
Practice Address - State:WA
Practice Address - Zip Code:98310-3374
Practice Address - Country:US
Practice Address - Phone:360-479-6154
Practice Address - Fax:360-479-5728
Is Sole Proprietor?:No
Enumeration Date:2007-08-28
Last Update Date:2012-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM6736207R00000X
WAMD60244388207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8AQ630OtherBCBS
TX8AQ630OtherBCBS