Provider Demographics
NPI:1467507038
Name:SRIVASTAVA, ASHWANI DAYAL (MD)
Entity Type:Individual
Prefix:DR
First Name:ASHWANI
Middle Name:DAYAL
Last Name:SRIVASTAVA
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 1:4305 W WHEATLAND RD STE 101
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75237-3455
Mailing Address - Country:US
Mailing Address - Phone:972-708-9494
Mailing Address - Fax:972-708-9498
Practice Address - Street 1:4305 W WHEATLAND RD STE 101
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75237-3455
Practice Address - Country:US
Practice Address - Phone:972-708-9494
Practice Address - Fax:972-798-9498
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2019-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL3488207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1916736-01Medicaid
TX8AW880OtherBCBS
TX8F7044Medicare PIN
TX8714B6Medicare PIN
TX8AW880OtherBCBS
TXP00457453Medicare PIN