Provider Demographics
NPI:1871354167
Name:DASU, TRIVIKRAM (PHD)
Entity type:Individual
Prefix:DR
First Name:TRIVIKRAM
Middle Name:
Last Name:DASU
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5846 DISTRIBUTION DR
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38141-8203
Mailing Address - Country:US
Mailing Address - Phone:757-275-5878
Mailing Address - Fax:
Practice Address - Street 1:5846 DISTRIBUTION DR
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38141-8203
Practice Address - Country:US
Practice Address - Phone:877-598-2522
Practice Address - Fax:901-495-2396
Is Sole Proprietor?:No
Enumeration Date:2024-01-23
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN26766246QI0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246QI0000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, PathologyImmunology