Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | MD00047649 | WA |
N | 207RA0201X | Internist - Allergy & Immunology | MD00047649 | WA |
NPI | 1396841169 |
---|---|
Provider Name | Dr. Renganathan Srinivasan |
First Address | Vancouver, WA 98664-1913 |
Second Address | Vancouver, WA 98686-2719 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/09/2006 |
Last Update Date | 28/12/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
8481277 | (05) | WA |
I73283 | (02) |