Provider Demographics
NPI:1427342575
Name:SREERAM, RADHIKA (MD)
Entity type:Individual
Prefix:
First Name:RADHIKA
Middle Name:
Last Name:SREERAM
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 1:51 SCHUYLER AVE
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06902-3730
Mailing Address - Country:US
Mailing Address - Phone:203-327-1187
Mailing Address - Fax:203-967-4218
Practice Address - Street 1:51 SCHUYLER AVE
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06902-3730
Practice Address - Country:US
Practice Address - Phone:203-327-1187
Practice Address - Fax:203-967-4218
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-07
Last Update Date:2021-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY276612207R00000X
CT69262207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine