Provider Demographics
NPI:1952502429
Name:PADMA, SRIKANTH (MD MBBS MS MCH DABS)
Entity Type:Individual
Prefix:DR
First Name:SRIKANTH
Middle Name:
Last Name:PADMA
Suffix:
Gender:M
Credentials:MD MBBS MS MCH DABS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6880 ANTLER CIR
Mailing Address - Street 2:
Mailing Address - City:WAUSAU
Mailing Address - State:WI
Mailing Address - Zip Code:54401-9431
Mailing Address - Country:US
Mailing Address - Phone:610-888-0199
Mailing Address - Fax:
Practice Address - Street 1:891 W MAIN ST STE 500
Practice Address - Street 2:
Practice Address - City:DOVER FOXCROFT
Practice Address - State:ME
Practice Address - Zip Code:04426-1064
Practice Address - Country:US
Practice Address - Phone:207-564-4466
Practice Address - Fax:207-564-4492
Is Sole Proprietor?:No
Enumeration Date:2007-05-30
Last Update Date:2022-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT178630204F00000X, 208600000X
MN54545208600000X, 2086X0206X
OK31557208600000X, 2086X0206X
DEC7-0001996208600000X
FLME138360208600000X, 2086X0206X
WI66188-20208600000X, 2086X0206X
PAMD433103208600000X, 2086X0206X, 2086X0206X
NC2007-01828208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology
No204F00000XAllopathic & Osteopathic PhysiciansTransplant Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5908840Medicaid