Provider Demographics
NPI:1598099376
Name:SRINIVASAN, JANARDHAN (MD)
Entity Type:Individual
Prefix:
First Name:JANARDHAN
Middle Name:
Last Name:SRINIVASAN
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 1:2232 WILBORN AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:SOUTH BOSTON
Mailing Address - State:VA
Mailing Address - Zip Code:24592-1662
Mailing Address - Country:US
Mailing Address - Phone:434-572-8977
Mailing Address - Fax:
Practice Address - Street 1:2232 WILBORN AVE
Practice Address - Street 2:
Practice Address - City:SOUTH BOSTON
Practice Address - State:VA
Practice Address - Zip Code:24592-1662
Practice Address - Country:US
Practice Address - Phone:434-572-8977
Practice Address - Fax:434-572-2510
Is Sole Proprietor?:No
Enumeration Date:2009-09-25
Last Update Date:2016-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101248603207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology