Provider Demographics
NPI:1689722100
Name:IYER, SRIRAM K (MD)
Entity Type:Individual
Prefix:
First Name:SRIRAM
Middle Name:K
Last Name:IYER
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:PO BOX 29
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41105-0029
Mailing Address - Country:US
Mailing Address - Phone:770-688-3806
Mailing Address - Fax:770-237-6089
Practice Address - Street 1:1100 SAINT CHRISTOPHER DR
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:KY
Practice Address - Zip Code:41101-7055
Practice Address - Country:US
Practice Address - Phone:606-327-4000
Practice Address - Fax:770-237-6089
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2009-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY31488207L00000X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64314883Medicaid
050053314OtherRAILROAD MEDICARE
G20599Medicare UPIN
KY64314883Medicaid
KY1553890Medicare PIN