Individual
MR. SRINIVAS BONTHU
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
169 RIVERSIDE DR, BINGHAMTON, NY 13905-4246
(518) 786-1291
(518) 786-1293
Mailing address
PO BOX 130, LATHAM, NY 12110-0130
(518) 786-1291
(518) 786-1293
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
197170
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02677521
—
NY
Enumeration date
02/15/2006
Last updated
05/24/2016
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