Individual
DR. PRASAD SRINIVASAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
622 HEBRON AVE STE 104B, GLASTONBURY, CT 06033-5003
(860) 659-8904
(860) 246-5828
Mailing address
622 HEBRON AVE STE 104B, GLASTONBURY, CT 06033-5003
(860) 659-8904
(860) 246-5828
Taxonomy
Speciality
Code
Description
License number
State
207K00000X
Allergy & Immunology Physician
Primary
022206
CT
207KA0200X
Allergy Physician
022206
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001222066
—
CT
01
—
030000070
MEDICARE ID
CT
01
—
C00280
MEDICARE
CT
Enumeration date
02/10/2006
Last updated
11/12/2024
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