Provider Demographics
NPI:1932114774
Name:DAMERA, SRIDEVI
Entity Type:Individual
Prefix:
First Name:SRIDEVI
Middle Name:
Last Name:DAMERA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6626 E. 75TH STREET
Mailing Address - Street 2:SUITE 500
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-2890
Mailing Address - Country:US
Mailing Address - Phone:317-355-2800
Mailing Address - Fax:317-355-2828
Practice Address - Street 1:2040 N SHADELAND AVE
Practice Address - Street 2:SUITE 130
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46219-1711
Practice Address - Country:US
Practice Address - Phone:317-355-2800
Practice Address - Fax:317-355-2828
Is Sole Proprietor?:No
Enumeration Date:2006-07-30
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01059476A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
INP00297544OtherRR MEDICARE
INP00942802OtherMEDICARE RR
IN000000376808OtherANTHEM
IN200527250Medicaid
IN200527250Medicaid
INP00297544OtherRR MEDICARE
ING79347Medicare UPIN