Provider Demographics
NPI:1225084155
Name:SRINIVASAN, PATTANAM DORAI (MD)
Entity type:Individual
Prefix:
First Name:PATTANAM
Middle Name:DORAI
Last Name:SRINIVASAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3740 EMBASSY CIR
Mailing Address - Street 2:
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34685-1016
Mailing Address - Country:US
Mailing Address - Phone:727-474-6507
Mailing Address - Fax:765-450-6161
Practice Address - Street 1:4738 GRAND BLVD STE G
Practice Address - Street 2:
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34652-5170
Practice Address - Country:US
Practice Address - Phone:727-474-6507
Practice Address - Fax:765-450-6161
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-25
Last Update Date:2025-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME124951208VP0014X, 207L00000X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200434770Medicaid
IN200434770Medicaid
IN232500AMedicare ID - Type Unspecified
INH81671Medicare UPIN