Provider Demographics
NPI:1801944632
Name:CHANNAPRAGADA, SRINIVAS (MD)
Entity type:Individual
Prefix:DR
First Name:SRINIVAS
Middle Name:
Last Name:CHANNAPRAGADA
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 1:43 GREEN HILL RD
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07081-3615
Mailing Address - Country:US
Mailing Address - Phone:908-522-0829
Mailing Address - Fax:908-522-0849
Practice Address - Street 1:43 GREEN HILL RD
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07081-3615
Practice Address - Country:US
Practice Address - Phone:908-522-0829
Practice Address - Fax:908-522-0849
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2008-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA05830600207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6877702Medicaid
NJJ5609NOtherHMO BLUE
NJ83438OtherAMERIGROUP
NJP384199OtherOXFORD
NJ575293OtherAETNA
NJ1115966OtherHORIZON MERCY
NJOK3622OtherHEALTH NET
NJ83438OtherAMERIGROUP