Provider Demographics
NPI:1538326772
Name:DRONAVALLI, SRIDHAR
Entity Type:Individual
Prefix:
First Name:SRIDHAR
Middle Name:
Last Name:DRONAVALLI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:419 W REDWOOD ST STE 240
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21201-7004
Mailing Address - Country:US
Mailing Address - Phone:410-328-5767
Mailing Address - Fax:
Practice Address - Street 1:419 W REDWOOD ST STE 160
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-1782
Practice Address - Country:US
Practice Address - Phone:410-328-3167
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-16
Last Update Date:2012-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0074405207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology