Provider Demographics
NPI:1952312662
Name:SASTRY, SRINIVAS M (MD)
Entity Type:Individual
Prefix:DR
First Name:SRINIVAS
Middle Name:M
Last Name:SASTRY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:10215 FERNWOOD RD
Mailing Address - Street 2:SUITE 305
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20817-1106
Mailing Address - Country:US
Mailing Address - Phone:301-843-9971
Mailing Address - Fax:301-843-9941
Practice Address - Street 1:10215 FERNWOOD RD
Practice Address - Street 2:SUITE 305
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20817-1106
Practice Address - Country:US
Practice Address - Phone:301-843-9971
Practice Address - Fax:301-843-9941
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD43360207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1277702OtherUNITED HEALTHCARE
MD349918OtherALLIANCE
MD490504Medicare ID - Type Unspecified
MD349918OtherALLIANCE