Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PP0204X | Pediatric Emergency Physician | MD472240 | PA |
NPI | 1609262120 |
---|---|
Provider Name | Sravya Ennamuri |
First Address | Rockland, DE 19732-0191 |
Second Address | Bryn Mawr, PA 19010-3143 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/04/2015 |
Last Update Date | 31/12/2020 |