Provider Demographics
NPI:1821190562
Name:POTHAMSETTY, SRIKIRAN (MD)
Entity Type:Individual
Prefix:DR
First Name:SRIKIRAN
Middle Name:
Last Name:POTHAMSETTY
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 1:1507 S HIAWASSEE RD
Mailing Address - Street 2:STE# 105
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32835-5718
Mailing Address - Country:US
Mailing Address - Phone:407-445-9224
Mailing Address - Fax:407-445-6236
Practice Address - Street 1:1507 S HIAWASSEE RD
Practice Address - Street 2:STE# 105
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32835-5718
Practice Address - Country:US
Practice Address - Phone:407-445-9224
Practice Address - Fax:407-445-6236
Is Sole Proprietor?:No
Enumeration Date:2006-09-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME82603207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLH49448Medicare UPIN
FL06244Medicare ID - Type Unspecified