Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2084N0402X | Child Neurologist | 25728 | MS |
NPI | 1033521513 |
---|---|
Provider Name | Dr. Varun Sreenivasan |
First Address | Madison, MS 39110-6115 |
Second Address | Madison, MS 39110-9299 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/06/2014 |
Last Update Date | 03/10/2019 |