Provider Demographics
NPI:1851352009
Name:DASARI, SRIRAM (MD)
Entity type:Individual
Prefix:
First Name:SRIRAM
Middle Name:
Last Name:DASARI
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 1:752 MEDICAL CENTER CT STE 101
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91911-6659
Mailing Address - Country:US
Mailing Address - Phone:615-250-9200
Mailing Address - Fax:619-397-4500
Practice Address - Street 1:752 MEDICAL CENTER CT STE 101
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91911-6659
Practice Address - Country:US
Practice Address - Phone:619-397-4500
Practice Address - Fax:858-429-7931
Is Sole Proprietor?:No
Enumeration Date:2006-03-29
Last Update Date:2025-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC202461208800000X
TNMD0000037489208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
4064639OtherBC
P00033877OtherRR MC
64072762OtherKY MCD
TN3886171Medicaid
TN3886171Medicaid
4064639OtherBC