Provider Demographics
NPI:1831114784
Name:SRIVASTAVA, ANUPAM (MD)
Entity Type:Individual
Prefix:
First Name:ANUPAM
Middle Name:
Last Name:SRIVASTAVA
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 1:2020 GOOD HOPE RD STE 100
Mailing Address - Street 2:
Mailing Address - City:ENOLA
Mailing Address - State:PA
Mailing Address - Zip Code:17025-1237
Mailing Address - Country:US
Mailing Address - Phone:717-728-3636
Mailing Address - Fax:717-728-3640
Practice Address - Street 1:2020 GOOD HOPE RD STE 100
Practice Address - Street 2:
Practice Address - City:ENOLA
Practice Address - State:PA
Practice Address - Zip Code:17025-1237
Practice Address - Country:US
Practice Address - Phone:717-728-3636
Practice Address - Fax:717-728-3640
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2022-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD 430149207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
112680Medicare PIN