Provider Demographics
NPI:1932308467
Name:SRIDHARA, SHANKAR KERALAPURA (MD)
Entity Type:Individual
Prefix:DR
First Name:SHANKAR
Middle Name:KERALAPURA
Last Name:SRIDHARA
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:300 HOSPITAL ROAD
Mailing Address - Street 2:EENT CLINIC
Mailing Address - City:FORT GORDON
Mailing Address - State:GA
Mailing Address - Zip Code:30905-5650
Mailing Address - Country:US
Mailing Address - Phone:706-787-7822
Mailing Address - Fax:706-787-2666
Practice Address - Street 1:300 HOSPITAL ROAD
Practice Address - Street 2:EENT CLINIC
Practice Address - City:FORT GORDON
Practice Address - State:GA
Practice Address - Zip Code:30905-5650
Practice Address - Country:US
Practice Address - Phone:706-787-7822
Practice Address - Fax:706-787-2666
Is Sole Proprietor?:No
Enumeration Date:2007-07-14
Last Update Date:2021-06-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101245003207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology