Provider Demographics
NPI:1245289016
Name:SRIDHAR, NAGARAJA R (MD)
Entity type:Individual
Prefix:DR
First Name:NAGARAJA
Middle Name:R
Last Name:SRIDHAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 ESSJAY RD STE 170
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-5782
Mailing Address - Country:US
Mailing Address - Phone:716-630-1219
Mailing Address - Fax:716-817-1726
Practice Address - Street 1:85 HIGH ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14203-1149
Practice Address - Country:US
Practice Address - Phone:716-857-8607
Practice Address - Fax:716-250-5914
Is Sole Proprietor?:No
Enumeration Date:2006-05-09
Last Update Date:2021-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY200509-1207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000524137002OtherHEALTH NOW
NY01601174Medicaid
NY200509-8BOtherWORKERS COMPENSATION
NY2507931OtherIHA
NY161000580OtherMERITAIN
NY0021748OtherGHI
NY161000580OtherUNITED HEALTHCARE
NY110209999OtherRR MEDICARE
NY161000580OtherNOVA
NY161000580OtherEMPIRE
NY00010171403OtherUNIVERA