Provider Demographics
NPI:1336341619
Name:ADARI, SRIVALLI (MD)
Entity type:Individual
Prefix:
First Name:SRIVALLI
Middle Name:
Last Name:ADARI
Suffix:
Gender:F
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:PO BOX 251382
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75025-1382
Mailing Address - Country:US
Mailing Address - Phone:469-408-9558
Mailing Address - Fax:888-393-5922
Practice Address - Street 1:4100 W 15TH ST
Practice Address - Street 2:100
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-5803
Practice Address - Country:US
Practice Address - Phone:469-408-9558
Practice Address - Fax:888-393-5922
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-31
Last Update Date:2020-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN2867207RI0200X, 207RG0300X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00798690OtherRR MEDICARE INDIVIDUAL #
833120OtherMEDICARE GROUP #
CA2264OtherRR MEDICARE GROUP #
833120013Medicare PIN
CA2264OtherRR MEDICARE GROUP #