Provider Demographics
NPI:1508038787
Name:BHANDARAM, SRIVIDYA (MD)
Entity Type:Individual
Prefix:DR
First Name:SRIVIDYA
Middle Name:
Last Name:BHANDARAM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:SRIVIDYA
Other - Middle Name:
Other - Last Name:VOOTUKURU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:130 RAMPART WAY
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80230-6440
Mailing Address - Country:US
Mailing Address - Phone:303-327-4700
Mailing Address - Fax:303-327-4711
Practice Address - Street 1:4545 E 9TH AVE STE 150
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80220-3906
Practice Address - Country:US
Practice Address - Phone:303-991-0993
Practice Address - Fax:303-531-6583
Is Sole Proprietor?:No
Enumeration Date:2008-03-28
Last Update Date:2021-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN104410207RN0300X
MN52400207RN0300X
OH57-012997207RN0300X
CO49537207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNENROLLEDMedicaid
MN110012850Medicare PIN