Provider Demographics
NPI:1841273729
Name:SRINIVASAN, VENKAT (MD)
Entity type:Individual
Prefix:DR
First Name:VENKAT
Middle Name:
Last Name:SRINIVASAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:VENKATASUBRAMANIAN
Other - Middle Name:
Other - Last Name:SRINIVASAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1151 DIRETTO DR
Mailing Address - Street 2:
Mailing Address - City:NEW BRAUNFELS
Mailing Address - State:TX
Mailing Address - Zip Code:78132-2739
Mailing Address - Country:US
Mailing Address - Phone:210-723-8418
Mailing Address - Fax:
Practice Address - Street 1:1151 DIRETTO DR
Practice Address - Street 2:
Practice Address - City:NEW BRAUNFELS
Practice Address - State:TX
Practice Address - Zip Code:78132-2739
Practice Address - Country:US
Practice Address - Phone:210-723-8418
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-23
Last Update Date:2025-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL5139207R00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX166565502Medicaid
TX8C0270Medicare ID - Type Unspecified