Provider Demographics
NPI:1144706979
Name:KOORAGAYALU, SREELAKSHMI (MD)
Entity type:Individual
Prefix:DR
First Name:SREELAKSHMI
Middle Name:
Last Name:KOORAGAYALU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16902 MOUNTAIN CLUB AVE
Mailing Address - Street 2:
Mailing Address - City:RAWLINGS
Mailing Address - State:MD
Mailing Address - Zip Code:21557-1041
Mailing Address - Country:US
Mailing Address - Phone:929-313-4430
Mailing Address - Fax:
Practice Address - Street 1:12500 WILLOWBROOK RD
Practice Address - Street 2:
Practice Address - City:CUMBERLAND
Practice Address - State:MD
Practice Address - Zip Code:21502-6393
Practice Address - Country:US
Practice Address - Phone:240-964-1200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-15
Last Update Date:2022-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH22596208M00000X
390200000X
MDD0090518207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program