Provider Demographics
NPI:1730144734
Name:KADIMI, SRINATH (MD)
Entity Type:Individual
Prefix:
First Name:SRINATH
Middle Name:
Last Name:KADIMI
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 1:75 KINGS HIGHWAY CUTOFF FL 5
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06824-5340
Mailing Address - Country:US
Mailing Address - Phone:203-333-1133
Mailing Address - Fax:203-333-3937
Practice Address - Street 1:75 KINGS HIGHWAY CUTOFF FL 5
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CT
Practice Address - Zip Code:06824-5340
Practice Address - Country:US
Practice Address - Phone:203-333-1133
Practice Address - Fax:203-333-3937
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2020-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD4495412084N0400X
SC394062084N0400X
TN568052084N0400X
MS255412084N0400X
ARE-117542084N0400X
CT0385252084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCL39406Medicaid
CT001385253Medicaid
CT010038525CT01OtherANTHEM BLUE CROSS AND BLU
CT001385253Medicaid
SCL39406Medicaid
CT130022002Medicare PIN