Provider Demographics
NPI:1851528103
Name:GOLI, SRIDHAR REDDY (MD,)
Entity Type:Individual
Prefix:DR
First Name:SRIDHAR
Middle Name:REDDY
Last Name:GOLI
Suffix:
Gender:M
Credentials:MD,
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Mailing Address - Street 1:1507 S HIAWASSEE RD STE 105
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32835-5706
Mailing Address - Country:US
Mailing Address - Phone:407-445-9224
Mailing Address - Fax:407-445-6236
Practice Address - Street 1:615 E PRINCETON ST STE 401
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32803
Practice Address - Country:US
Practice Address - Phone:407-303-9926
Practice Address - Fax:407-303-9928
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-14
Last Update Date:2018-07-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME1246102080P0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0206XAllopathic & Osteopathic PhysiciansPediatricsPediatric Gastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL015728700Medicaid