Provider Demographics
NPI:1639372949
Name:TAMIRISA, SRINATH KRISHNAMACHARY (MD)
Entity type:Individual
Prefix:
First Name:SRINATH
Middle Name:KRISHNAMACHARY
Last Name:TAMIRISA
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 1:9250 E COSTILLA AVE STE 540
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD VILLAGE
Mailing Address - State:CO
Mailing Address - Zip Code:80112-3648
Mailing Address - Country:US
Mailing Address - Phone:720-644-9355
Mailing Address - Fax:720-523-1654
Practice Address - Street 1:9250 E COSTILLA AVE STE 540
Practice Address - Street 2:
Practice Address - City:GREENWOOD VILLAGE
Practice Address - State:CO
Practice Address - Zip Code:80112-3648
Practice Address - Country:US
Practice Address - Phone:720-644-9355
Practice Address - Fax:720-523-1654
Is Sole Proprietor?:No
Enumeration Date:2007-06-06
Last Update Date:2024-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN7981207R00000X, 207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine