Provider Demographics
NPI:1720391600
Name:PRATIBHA SRINIVASAN
Entity Type:Organization
Organization Name:PRATIBHA SRINIVASAN
Other - Org Name:SMART EARS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SOLE PROPRIETOR AND AUDIOLOGIST
Authorized Official - Prefix:MS
Authorized Official - First Name:PRATIBHA
Authorized Official - Middle Name:
Authorized Official - Last Name:SRINIVASAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-399-4066
Mailing Address - Street 1:1019 DAWNWOOD RD
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23114-4489
Mailing Address - Country:US
Mailing Address - Phone:804-399-4066
Mailing Address - Fax:703-891-9854
Practice Address - Street 1:220 S WASHINGTON ST
Practice Address - Street 2:#203
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22314-3626
Practice Address - Country:US
Practice Address - Phone:804-399-4066
Practice Address - Fax:703-891-9854
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-20
Last Update Date:2010-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2201000379231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA9450025Medicaid
VA352434OtherANTHEM
VAM986OtherCAREFIRST BCBS