Provider Demographics
NPI:1750369385
Name:YARRA, SRINADH (MD)
Entity type:Individual
Prefix:
First Name:SRINADH
Middle Name:
Last Name:YARRA
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 1:301 PROSPECT AVE
Mailing Address - Street 2:HOSPITAL INTERNISTS
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13203-1807
Mailing Address - Country:US
Mailing Address - Phone:315-448-5704
Mailing Address - Fax:315-423-6853
Practice Address - Street 1:301 PROSPECT AVE
Practice Address - Street 2:HOSPITAL INTERNISTS
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13203-1807
Practice Address - Country:US
Practice Address - Phone:315-448-5704
Practice Address - Fax:315-423-6853
Is Sole Proprietor?:No
Enumeration Date:2006-01-04
Last Update Date:2019-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY238163207R00000X
NY238163-1208M00000X
MO2017039562208M00000X
IN99081374A207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02723119Medicaid
NY02723119Medicaid
I49651Medicare UPIN
NYRB3056Medicare PIN