Provider Demographics
NPI:1457510059
Name:SRINIVASAN, SRIRAMAN RAM (MD)
Entity Type:Individual
Prefix:
First Name:SRIRAMAN
Middle Name:RAM
Last Name:SRINIVASAN
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 1:19775 WILLOWDALE PL
Mailing Address - Street 2:
Mailing Address - City:ASHBURN
Mailing Address - State:VA
Mailing Address - Zip Code:20147-5209
Mailing Address - Country:US
Mailing Address - Phone:917-769-1216
Mailing Address - Fax:866-497-1239
Practice Address - Street 1:3 BETHESDA METRO CTR STE 525
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20814-6424
Practice Address - Country:US
Practice Address - Phone:314-514-6000
Practice Address - Fax:866-497-1239
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-09
Last Update Date:2022-08-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LA332724207R00000X, 207RC0200X
VA0101243990207RC0200X
MDD74074207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC184098YT2Medicare PIN