Provider Demographics
NPI:1497755771
Name:VANGARA, SREENIVAS P (MD)
Entity Type:Individual
Prefix:MR
First Name:SREENIVAS
Middle Name:P
Last Name:VANGARA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:5515 GULF DR
Mailing Address - Street 2:STE B
Mailing Address - City:NEW PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34652-4033
Mailing Address - Country:US
Mailing Address - Phone:727-848-3995
Mailing Address - Fax:727-843-9400
Practice Address - Street 1:5515 GULF DR
Practice Address - Street 2:STE B
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34652-4033
Practice Address - Country:US
Practice Address - Phone:727-848-3995
Practice Address - Fax:727-843-9400
Is Sole Proprietor?:No
Enumeration Date:2005-07-28
Last Update Date:2009-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0073512207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
10284201OtherCITRUS
207438OtherAMERIGROUP
244209OtherAVMED
29-87441OtherUHC
22749OtherWELLCARE
FL253520300Medicaid
42633OtherBCBS
5319635OtherAETNA
F82301Medicare UPIN
FL253520300Medicaid
22749OtherWELLCARE