Provider Demographics
NPI:1801995352
Name:GOWDA, SRISAI (MD)
Entity type:Individual
Prefix:DR
First Name:SRISAI
Middle Name:
Last Name:GOWDA
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:#2106, NEW ROAD
Mailing Address - Street 2:D-8
Mailing Address - City:LINWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08221
Mailing Address - Country:US
Mailing Address - Phone:609-927-1030
Mailing Address - Fax:609-927-9985
Practice Address - Street 1:#2106, NEW ROAD
Practice Address - Street 2:D-8
Practice Address - City:LINWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08221
Practice Address - Country:US
Practice Address - Phone:609-927-1030
Practice Address - Fax:609-927-9985
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2019-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA0655332084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7375204Medicaid
NJ7375204Medicaid
G55833Medicare UPIN