Provider Demographics
NPI:1972770204
Name:PINNAMANENI, SRIDHAR (MD)
Entity type:Individual
Prefix:
First Name:SRIDHAR
Middle Name:
Last Name:PINNAMANENI
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 1:8136 CENTRALIA CT
Mailing Address - Street 2:STE 103
Mailing Address - City:LEESBURG
Mailing Address - State:FL
Mailing Address - Zip Code:34788-3757
Mailing Address - Country:US
Mailing Address - Phone:352-343-7246
Mailing Address - Fax:352-259-8959
Practice Address - Street 1:8136 CENTRALIA CT
Practice Address - Street 2:STE 103
Practice Address - City:LEESBURG
Practice Address - State:FL
Practice Address - Zip Code:34788-3757
Practice Address - Country:US
Practice Address - Phone:352-343-7246
Practice Address - Fax:352-259-8959
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-15
Last Update Date:2015-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME100408208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000553300Medicaid
FL47618OtherBCBS
FL47618OtherBCBS