Provider Demographics
NPI:1639323041
Name:SRINIVAS DONTINENI MD PA
Entity Type:Organization
Organization Name:SRINIVAS DONTINENI MD PA
Other - Org Name:BREVARD HOSPITALIST ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:INTERNAL MEDICINE PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:SRINIVAS
Authorized Official - Middle Name:RAO
Authorized Official - Last Name:DONTINENI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:321-751-9506
Mailing Address - Street 1:PO BOX 560059
Mailing Address - Street 2:
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32956-0059
Mailing Address - Country:US
Mailing Address - Phone:321-751-9506
Mailing Address - Fax:321-751-9505
Practice Address - Street 1:2800 AURORA RD STE F
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32935-2015
Practice Address - Country:US
Practice Address - Phone:321-368-3862
Practice Address - Fax:321-208-8717
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-12
Last Update Date:2020-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLBM919AOtherMEDICARE PTAN
FL004793700Medicaid
FL82027ZMedicare PIN