Provider Demographics
NPI:1881884021
Name:ALLE, SRINESH (MD)
Entity type:Individual
Prefix:
First Name:SRINESH
Middle Name:
Last Name:ALLE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 844527
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02284-4527
Mailing Address - Country:US
Mailing Address - Phone:757-867-6101
Mailing Address - Fax:757-750-3665
Practice Address - Street 1:736 BATTLEFIELD BLVD N
Practice Address - Street 2:DEPARTMENT OF RADIOLOGY
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-4941
Practice Address - Country:US
Practice Address - Phone:757-312-6124
Practice Address - Fax:757-312-6195
Is Sole Proprietor?:No
Enumeration Date:2007-07-25
Last Update Date:2024-02-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA01012455312085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1058025Medicaid
VA1881884021Medicaid
VA019582C88Medicare PIN