Provider Demographics
NPI:1841237526
Name:DUVVURI, SRINIVAS (MD)
Entity Type:Individual
Prefix:
First Name:SRINIVAS
Middle Name:
Last Name:DUVVURI
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 1:11 RALPH PLACE
Mailing Address - Street 2:SUITE 109
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10304-4419
Mailing Address - Country:US
Mailing Address - Phone:718-981-2684
Mailing Address - Fax:718-981-5003
Practice Address - Street 1:11 RALPH PLACE
Practice Address - Street 2:SUITE 109
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10304-4419
Practice Address - Country:US
Practice Address - Phone:718-981-2684
Practice Address - Fax:718-981-5003
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2022-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY192451207RI0011X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY4637405OtherAETNA/US HEALTHCARE
NY01001582Medicaid
NY10219POtherHIP HEALTHCARE
NY4637405OtherAETNA/US HEALTHCARE
NY10219POtherHIP HEALTHCARE