Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | 022206 | CT |
N | 207KA0200X | Allergist | 022206 | CT |
NPI | 1740253517 |
---|---|
Provider Name | Dr. Prasad Srinivasan |
First Address | Glastonbury, CT 06033-2246 |
Second Address | Glastonbury, CT 06033 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/02/2006 |
Last Update Date | 15/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
001222066 | (05) | CT |
030000070 | MEDICARE ID (01) | CT |
B83427 | (02) | CT |
C00280 | MEDICARE (01) | CT |