Provider Demographics
NPI:1801937727
Name:SRINIVASAN, GEETHA (MD)
Entity type:Individual
Prefix:
First Name:GEETHA
Middle Name:
Last Name:SRINIVASAN
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 1:8 FORRESTAL RD S STE 208
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08540-6658
Mailing Address - Country:US
Mailing Address - Phone:609-227-0105
Mailing Address - Fax:855-576-5170
Practice Address - Street 1:8 FORRESTAL RD S STE 208
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:NJ
Practice Address - Zip Code:08540-6658
Practice Address - Country:US
Practice Address - Phone:609-799-6085
Practice Address - Fax:855-576-5170
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2024-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06836700207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ204543356OtherTAX ID NUMBER
NJ223457805OtherTAX ID NUMBER
NJH00148Medicare UPIN
NJ885917Medicare ID - Type Unspecified