Provider Demographics
NPI:1356344402
Name:SRINATH, MANOJ (MD)
Entity type:Individual
Prefix:DR
First Name:MANOJ
Middle Name:
Last Name:SRINATH
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 1:135 W RAVINE RD STE 3-A
Mailing Address - Street 2:
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37660-3847
Mailing Address - Country:US
Mailing Address - Phone:423-246-6777
Mailing Address - Fax:423-246-7766
Practice Address - Street 1:235 MEDICAL PARK BLVD
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:TN
Practice Address - Zip Code:37620-7455
Practice Address - Country:US
Practice Address - Phone:423-274-6350
Practice Address - Fax:423-274-6354
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN035088207RG0100X
VA0101230824207RG0100X
TNMD 35088207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA5856531Medicaid
TN3700035Medicaid
TN3862641Medicaid
TN3862641Medicaid
TN3862644Medicare ID - Type Unspecified
TN0281780003Medicare PIN
TN0281780001Medicare PIN
TN103I086169Medicare UPIN
VA5856531Medicaid
TNCA5023Medicare PIN
TN100015117Medicare PIN