Individual
DR. INDRA SRIRAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
168 CAROLINA RIDGE DR, COLUMBIA, SC 29229-7396
(260) 602-4645
Mailing address
168 CAROLINA RIDGE DR, COLUMBIA, SC 29229-7396
(260) 602-4645
Taxonomy
Speciality
Code
Description
License number
State
207RA0000X
Adolescent Medicine (Internal Medicine) Physician
01040404
IN
207RA0000X
Adolescent Medicine (Internal Medicine) Physician
Primary
MMD.36130 MD
SC
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
01040404
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100439910
—
IN
Enumeration date
06/22/2005
Last updated
07/10/2014
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