Provider Demographics
NPI:1285621599
Name:PADMANABHAN, SRIRANGAM (MD)
Entity type:Individual
Prefix:DR
First Name:SRIRANGAM
Middle Name:
Last Name:PADMANABHAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:354 MERRIMACK ST
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:MA
Mailing Address - Zip Code:01843-1754
Mailing Address - Country:US
Mailing Address - Phone:978-687-2321
Mailing Address - Fax:978-685-7265
Practice Address - Street 1:354 MERRIMACK ST
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:MA
Practice Address - Zip Code:01843-1754
Practice Address - Country:US
Practice Address - Phone:978-687-2321
Practice Address - Fax:978-685-7265
Is Sole Proprietor?:No
Enumeration Date:2005-10-03
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA81841208100000X
NH7008208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH00000140Medicaid
MA23-00009OtherUHC
MA23-00146OtherEVERCARE
MA3002621OtherNHP
NH0103555Y0MA01OtherANTHEM
MA4390814OtherAETNA
MH5149017-001OtherCIGNA
MAC66011OtherHPHC
MA6188591Medicaid
MA715267OtherTHP
MA29064OtherFCHP
MAJ16833OtherBCBS
MAC66011OtherHPHC
MA23-00009OtherUHC
MA29064OtherFCHP