Basic Information
| Provider Information | |||||||||
| NPI: | 1598877987 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SRIVASTAVA | ||||||||
| FirstName: | TRIBENI | ||||||||
| MiddleName: | NARAIN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7 WOODLAKE TRL | ||||||||
| Address2: | |||||||||
| City: | MOUNT VERNON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 430508103 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7403970108 | ||||||||
| FaxNumber: | 7403970800 | ||||||||
| Practice Location | |||||||||
| Address1: | 7 WOODLAKE TRL | ||||||||
| Address2: | |||||||||
| City: | MOUNT VERNON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 430508103 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7403970108 | ||||||||
| FaxNumber: | 7403970800 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/31/2006 | ||||||||
| LastUpdateDate: | 12/14/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | 35.033528 | OH | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
ID Information
| ID | Type | State | Issuer | Description | 060064107 | 01 | RAILROAD MEDICARE | OTHER | 2215838 | 05 | OH | MEDICAID |