Provider Demographics
NPI:1649265034
Name:PADMANABHAN, SRIRAM (MD)
Entity type:Individual
Prefix:
First Name:SRIRAM
Middle Name:
Last Name:PADMANABHAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1838 GREENE TREE RD
Mailing Address - Street 2:SUITE 150- LL
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21208-6391
Mailing Address - Country:US
Mailing Address - Phone:410-602-9262
Mailing Address - Fax:410-602-9276
Practice Address - Street 1:9105 FRANKLIN SQUARE DR
Practice Address - Street 2:SUITE 209
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21237-3930
Practice Address - Country:US
Practice Address - Phone:410-602-9262
Practice Address - Fax:410-602-9276
Is Sole Proprietor?:No
Enumeration Date:2005-09-13
Last Update Date:2010-08-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD0061413207RC0000X, 207UN0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD408067000Medicaid
MD408067000Medicaid
H36376Medicare UPIN