Individual
SRINIVAS RAJAMAHANTY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
305 W JACKSON ST STE 301, CARBONDALE, IL 62901-1474
(618) 351-9300
(618) 351-9307
Mailing address
PO BOX 3988, CARBONDALE, IL 62902-3988
(618) 457-5200
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
036127544
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036127544
—
IL
05
—
5915178
—
NC
Enumeration date
07/01/2010
Last updated
10/24/2022
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