Provider Demographics
NPI:1831680404
Name:SRINIVASAN, MAYA DEEPTI (MD)
Entity Type:Individual
Prefix:DR
First Name:MAYA
Middle Name:DEEPTI
Last Name:SRINIVASAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:450 CLARKSON AVENUE
Mailing Address - Street 2:DEPARTMENT OF MEDICINE
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11201
Mailing Address - Country:US
Mailing Address - Phone:718-270-1566
Mailing Address - Fax:
Practice Address - Street 1:SUNY DOWNSTATE MEDICAL CENTER
Practice Address - Street 2:450 CLARKSON AVENUE, 1262
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11203
Practice Address - Country:US
Practice Address - Phone:412-607-2233
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-19
Last Update Date:2018-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program