Provider Demographics
NPI:1821519109
Name:JAGANNATHAN, SREENATH (DO)
Entity Type:Individual
Prefix:
First Name:SREENATH
Middle Name:
Last Name:JAGANNATHAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 TREADWAY CT
Mailing Address - Street 2:
Mailing Address - City:NOTTINGHAM
Mailing Address - State:MD
Mailing Address - Zip Code:21236-5442
Mailing Address - Country:US
Mailing Address - Phone:410-409-7438
Mailing Address - Fax:
Practice Address - Street 1:145 N 6TH ST FL 1
Practice Address - Street 2:
Practice Address - City:READING
Practice Address - State:PA
Practice Address - Zip Code:19601-3096
Practice Address - Country:US
Practice Address - Phone:610-208-4558
Practice Address - Fax:610-378-2441
Is Sole Proprietor?:No
Enumeration Date:2017-06-27
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOT018018390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program