Provider Demographics
NPI:1669467155
Name:DONTINENI, SRINIVAS RAO (MD)
Entity Type:Individual
Prefix:DR
First Name:SRINIVAS
Middle Name:RAO
Last Name:DONTINENI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2800 AURORA RD
Mailing Address - Street 2:STE F
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32935-2015
Mailing Address - Country:US
Mailing Address - Phone:321-795-6380
Mailing Address - Fax:321-208-8515
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
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-12
Last Update Date:2020-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME88036207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL268191900Medicaid
FL82027OtherBLUE CROSS BLUE SHIELD
FL268191900Medicaid
H96986Medicare UPIN