Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 0101268694 | VA |
N | 207X00000X | Orthopaedic Surgeon | LT000393 | PA |
N | 207XX0004X | Foot and Ankle Orthopaedic Surgeon | LT000393 | PA |
N | 207XX0005X | Sports Medicine Orthopaedic Surgeon | MT217233 | PA |
NPI | 1669957916 |
---|---|
Provider Name | Dr. Sreenivasulu Metikala |
First Address | South Hill, VA 23970-0623 |
Second Address | South Hill, VA 23970-4080 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/10/2018 |
Last Update Date | 30/07/2021 |