Provider Demographics
NPI:1942601695
Name:SRIRAMULA, SRIVIDYA (MD)
Entity Type:Individual
Prefix:
First Name:SRIVIDYA
Middle Name:
Last Name:SRIRAMULA
Suffix:
Gender:F
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:PO BOX 909
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202-0909
Mailing Address - Country:US
Mailing Address - Phone:502-562-3000
Mailing Address - Fax:
Practice Address - Street 1:2195 HARRODSBURG RD STE 125
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40504-3543
Practice Address - Country:US
Practice Address - Phone:859-323-2232
Practice Address - Fax:859-257-1078
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-12
Last Update Date:2022-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYTP780207R00000X
KY50491208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist