Provider Demographics
NPI:1427088897
Name:POTLURI, SRINIVASA RAO (MD)
Entity type:Individual
Prefix:DR
First Name:SRINIVASA
Middle Name:RAO
Last Name:POTLURI
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:676 US HIGHWAY 202/206
Mailing Address - Street 2:BLDG 2
Mailing Address - City:BRIDGEWATER
Mailing Address - State:NJ
Mailing Address - Zip Code:08807-1761
Mailing Address - Country:US
Mailing Address - Phone:908-218-1180
Mailing Address - Fax:908-218-1718
Practice Address - Street 1:676 US HIGHWAY 202/206
Practice Address - Street 2:BLDG 2
Practice Address - City:BRIDGEWATER
Practice Address - State:NJ
Practice Address - Zip Code:08807-1761
Practice Address - Country:US
Practice Address - Phone:908-218-1180
Practice Address - Fax:908-218-1718
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA071375002084N0400X, 2084N0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical Neurophysiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
2K4368OtherHEALTHNET
5148191OtherCIGNA
NJ8686301Medicaid
9001121440OtherHORIZON BLUECROSS BLUESHI
211930200OtherAMERIHEALTH HMO
2229034000OtherAMERIHEALTH PPO
3342020OtherAETNA INDIVIDUAL
900112144OtherUNITED HEALTH CARE
P00091708OtherMEDICARE RAILROAD
90-0112144OtherQUALCARE
P2486490OtherOXFORD
3342021OtherAETNA GROUP ID NUMBER