Provider Demographics
NPI:1245952985
Name:SRIG MED LLC
Entity type:Organization
Organization Name:SRIG MED LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:ATCHUTHA GEETHA CHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:CHILAKAMARRI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-439-8812
Mailing Address - Street 1:11829 PEPPERVINE DR # 20871
Mailing Address - Street 2:
Mailing Address - City:CLARKSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20871-6312
Mailing Address - Country:US
Mailing Address - Phone:240-393-6880
Mailing Address - Fax:
Practice Address - Street 1:21030 FREDERICK RD STE 102G
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:MD
Practice Address - Zip Code:20876-4133
Practice Address - Country:US
Practice Address - Phone:240-393-6880
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-19
Last Update Date:2022-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric MedicineGroup - Multi-Specialty
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Multi-Specialty