Provider Demographics
NPI:1457682536
Name:SRINIVASAN, MARIA CRISTINA (MD)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:CRISTINA
Last Name:SRINIVASAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MARIA
Other - Middle Name:CRISTINA
Other - Last Name:ANTONIE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:945 E GENESEE ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13210-1752
Mailing Address - Country:US
Mailing Address - Phone:315-475-8401
Mailing Address - Fax:315-475-0824
Practice Address - Street 1:945 E GENESEE ST
Practice Address - Street 2:SUITE 200
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13210-1752
Practice Address - Country:US
Practice Address - Phone:315-475-8401
Practice Address - Fax:315-475-0824
Is Sole Proprietor?:No
Enumeration Date:2010-01-29
Last Update Date:2013-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY270987207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03629352Medicaid
NY03629352Medicaid