Provider Demographics
NPI:1316947997
Name:SRINIVASAN, ARVIND (MD)
Entity type:Individual
Prefix:DR
First Name:ARVIND
Middle Name:
Last Name:SRINIVASAN
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 1:1009 FOWLER AVE
Mailing Address - Street 2:
Mailing Address - City:BERWICK
Mailing Address - State:PA
Mailing Address - Zip Code:18603-2305
Mailing Address - Country:US
Mailing Address - Phone:570-759-6491
Mailing Address - Fax:570-759-2440
Practice Address - Street 1:140 N. SHERMAN CT
Practice Address - Street 2:
Practice Address - City:HAZLETON
Practice Address - State:PA
Practice Address - Zip Code:18201
Practice Address - Country:US
Practice Address - Phone:570-450-6333
Practice Address - Fax:570-450-6571
Is Sole Proprietor?:No
Enumeration Date:2005-07-26
Last Update Date:2018-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD051265L208800000X
NJ25MA10291400208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001715561004Medicaid
PA0017155610004Medicaid
PA0017155610004Medicaid
PAG50380Medicare UPIN