Provider Demographics
NPI:1548591340
Name:SRIVASTAV, SUSHMITA (MD)
Entity Type:Individual
Prefix:DR
First Name:SUSHMITA
Middle Name:
Last Name:SRIVASTAV
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:SUSHMITA
Other - Middle Name:
Other - Last Name:SINHA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MBBS
Mailing Address - Street 1:5730 EXECUTIVE DR STE 230
Mailing Address - Street 2:
Mailing Address - City:CATONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21228-1762
Mailing Address - Country:US
Mailing Address - Phone:908-516-9245
Mailing Address - Fax:908-516-9265
Practice Address - Street 1:535 MOUNTAIN AVE
Practice Address - Street 2:
Practice Address - City:NEW PROVIDENCE
Practice Address - State:NJ
Practice Address - Zip Code:07974
Practice Address - Country:US
Practice Address - Phone:903-516-9245
Practice Address - Fax:908-516-9265
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-19
Last Update Date:2023-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA09000300207R00000X, 207RG0300X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist