Individual
SHANTANU SRINIVASAN KIDAMBI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
55 LAKE AVE N, DEPARTMENT OF ANESTHESIOLOGY, WORCESTER, MA 01655-0002
(508) 334-3271
(508) 856-5911
Mailing address
PO BOX 415348, BOSTON, MA 02241-5348
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
047523
CT
207L00000X
Anesthesiology Physician
Primary
226541
MA
207L00000X
Anesthesiology Physician
33123
NH
207L00000X
Anesthesiology Physician
ME94938
FL
207L00000X
Anesthesiology Physician
P4663
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110084186A
—
MA
Enumeration date
01/20/2007
Last updated
08/05/2024
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