Provider Demographics
NPI:1134820277
Name:SRIRANGAPATANAM, SUDARSHAN V (BA)
Entity type:Individual
Prefix:MR
First Name:SUDARSHAN
Middle Name:V
Last Name:SRIRANGAPATANAM
Suffix:
Gender:M
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 PARNASSUS AVE # A610
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94143-2202
Mailing Address - Country:US
Mailing Address - Phone:415-885-7748
Mailing Address - Fax:
Practice Address - Street 1:400 PARNASSUS AVE # A610
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94143-2202
Practice Address - Country:US
Practice Address - Phone:415-885-7748
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-15
Last Update Date:2024-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPTL15548208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology