Provider Demographics
NPI:1871564237
Name:SRINIVASAN, SUBASREE (MD)
Entity type:Individual
Prefix:DR
First Name:SUBASREE
Middle Name:
Last Name:SRINIVASAN
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 1:2890 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:STRATFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06614-4980
Mailing Address - Country:US
Mailing Address - Phone:203-383-4466
Mailing Address - Fax:203-383-4466
Practice Address - Street 1:2890 MAIN ST
Practice Address - Street 2:
Practice Address - City:STRATFORD
Practice Address - State:CT
Practice Address - Zip Code:06614-4980
Practice Address - Country:US
Practice Address - Phone:203-383-4466
Practice Address - Fax:203-383-4466
Is Sole Proprietor?:No
Enumeration Date:2006-02-01
Last Update Date:2011-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT033279207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT061608343OtherUNITED HEALTHCARE
CT061608343OtherCIGNA
CT010033279CT04OtherBLUE CROSS
CT3717982OtherAETNA
CT706315OtherCT CARE
CT3717982OtherAETNA
CT010033279CT04OtherBLUE CROSS