Provider Demographics
NPI:1710065586
Name:RAMACHANDRA, SRINIVAS R (MD)
Entity Type:Individual
Prefix:
First Name:SRINIVAS
Middle Name:R
Last Name:RAMACHANDRA
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 1:1320 EL CAPITAN DR STE 120
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:94526-6260
Mailing Address - Country:US
Mailing Address - Phone:510-579-2345
Mailing Address - Fax:
Practice Address - Street 1:1320 EL CAPITAN DR STE 120
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:CA
Practice Address - Zip Code:94526-6260
Practice Address - Country:US
Practice Address - Phone:510-579-2345
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2022-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA38624208D00000X, 2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A386240Medicaid
CA00A386240Medicaid
00A386240Medicare ID - Type Unspecified