Provider Demographics
NPI:1538157904
Name:ANNAMRAJU, SRINIVAS (MD)
Entity type:Individual
Prefix:
First Name:SRINIVAS
Middle Name:
Last Name:ANNAMRAJU
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 1:717 E PITTSBURGH ST
Mailing Address - Street 2:
Mailing Address - City:GREENSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15601-2636
Mailing Address - Country:US
Mailing Address - Phone:724-832-8004
Mailing Address - Fax:724-837-1870
Practice Address - Street 1:717 E PITTSBURGH ST
Practice Address - Street 2:
Practice Address - City:GREENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15601-2636
Practice Address - Country:US
Practice Address - Phone:724-832-8004
Practice Address - Fax:724-837-1870
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-11
Last Update Date:2022-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD044300L2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0015363550001Medicaid
PA0784304OtherBS
PA300055885OtherRR MED
PA0015363550001Medicaid
PA0015363550001Medicaid