Provider Demographics
NPI:1699987172
Name:SRIDHAR CHATRATHI MD PC
Entity type:Organization
Organization Name:SRIDHAR CHATRATHI MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SRIDHAR
Authorized Official - Middle Name:
Authorized Official - Last Name:CHATRATHI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-220-2220
Mailing Address - Street 1:7500 HANOVER PARKWAY
Mailing Address - Street 2:SUITE 105-A
Mailing Address - City:GREENBELT
Mailing Address - State:MD
Mailing Address - Zip Code:20770
Mailing Address - Country:US
Mailing Address - Phone:301-220-2220
Mailing Address - Fax:301-220-2224
Practice Address - Street 1:7500 HANOVER PARKWAY
Practice Address - Street 2:SUITE 105-A
Practice Address - City:GREENBELT
Practice Address - State:MD
Practice Address - Zip Code:20770
Practice Address - Country:US
Practice Address - Phone:301-220-2220
Practice Address - Fax:301-220-2224
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-04
Last Update Date:2018-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD680111100Medicaid