Provider Demographics
NPI:1851344360
Name:TIRUMALAREDDY, SRINIVASA R (MD)
Entity Type:Individual
Prefix:
First Name:SRINIVASA
Middle Name:R
Last Name:TIRUMALAREDDY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 820137
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19182-0137
Mailing Address - Country:US
Mailing Address - Phone:610-270-2352
Mailing Address - Fax:610-270-2358
Practice Address - Street 1:559 W GERMANTOWN PIKE
Practice Address - Street 2:
Practice Address - City:EAST NORRITON
Practice Address - State:PA
Practice Address - Zip Code:19403-4250
Practice Address - Country:US
Practice Address - Phone:484-622-7071
Practice Address - Fax:484-622-4260
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2012-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD427298207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA11551039OtherCAQH ID#
PA30027296OtherKEYSTONE MERCY
PA7791748OtherAETNA PPO
PA1166904OtherAETNA HMO
PA1783127OtherHIGHMARK BLUE SHIELD
PA2620467000OtherIBC - PC/KHPE
PA1014433750001Medicaid
PA2620467000OtherAMERIHEALTH/INTERCOUNTY
PAI47680Medicare UPIN
PA1014433750001Medicaid