Provider Demographics
NPI:1699720508
Name:MOVVA, SRINIVASA RAO (MD)
Entity type:Individual
Prefix:DR
First Name:SRINIVASA
Middle Name:RAO
Last Name:MOVVA
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 1:37 E WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:ATLANTIC HIGHLANDS
Mailing Address - State:NJ
Mailing Address - Zip Code:07716-1327
Mailing Address - Country:US
Mailing Address - Phone:783-291-3430
Mailing Address - Fax:732-291-5659
Practice Address - Street 1:37 E WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:ATLANTIC HIGHLANDS
Practice Address - State:NJ
Practice Address - Zip Code:07716-1327
Practice Address - Country:US
Practice Address - Phone:783-291-3430
Practice Address - Fax:732-291-5659
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-23
Last Update Date:2010-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA6591900207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7704305Medicaid
NJG79633Medicare UPIN
NJ7704305Medicaid