Provider Demographics
NPI:1780782185
Name:SRIVASTAVA, ALKA (MD)
Entity type:Individual
Prefix:
First Name:ALKA
Middle Name:
Last Name:SRIVASTAVA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:830 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:13601-4034
Mailing Address - Country:US
Mailing Address - Phone:315-785-4673
Mailing Address - Fax:315-788-4248
Practice Address - Street 1:830 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:NY
Practice Address - Zip Code:13601-4099
Practice Address - Country:US
Practice Address - Phone:315-785-4673
Practice Address - Fax:315-788-4248
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY248091207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02239283Medicaid
NYDD0075Medicare PIN
NY06000248091Medicaid
NYH53332Medicare UPIN