Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 203402 | LA |
N | 111NI0900X | Internist | 203402 | LA |
Y | 207RH0000X | Hematologist | 35133922 | OH |
N | 207RH0003X | Hematology & Oncology | 203402 | LA |
NPI | 1154595049 |
---|---|
Provider Name | Srinivas S. Devarakonda |
First Address | Columbus, OH 43202-1559 |
Second Address | Columbus, OH 43210-1240 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/04/2008 |
Last Update Date | 18/12/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0286667 | (05) | OH |
1807702 | (05) | LA |
4M546F600 | MEDICARE - PTAN (01) | LA |