Basic Information
| Provider Information | |||||||||
| NPI: | 1730144734 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KADIMI | ||||||||
| FirstName: | SRINATH | ||||||||
| MiddleName: | |||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 75 KINGS HIGHWAY CUTOFF FL 5 | ||||||||
| Address2: | |||||||||
| City: | FAIRFIELD | ||||||||
| State: | CT | ||||||||
| PostalCode: | 068245340 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2033331133 | ||||||||
| FaxNumber: | 2033333937 | ||||||||
| Practice Location | |||||||||
| Address1: | 75 KINGS HIGHWAY CUTOFF FL 5 | ||||||||
| Address2: | |||||||||
| City: | FAIRFIELD | ||||||||
| State: | CT | ||||||||
| PostalCode: | 068245340 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2033331133 | ||||||||
| FaxNumber: | 2033333937 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/20/2006 | ||||||||
| LastUpdateDate: | 02/11/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/11/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084N0400X | MD449541 | PA | N | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology | 2084N0400X | 39406 | SC | N | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology | 2084N0400X | 56805 | TN | N | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology | 2084N0400X | 25541 | MS | N | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology | 2084N0400X | E-11754 | AR | N | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology | 2084N0400X | 038525 | CT | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology |
ID Information
| ID | Type | State | Issuer | Description | L39406 | 05 | SC | MEDICAID | 001385253 | 05 | CT | MEDICAID | 010038525CT01 | 01 | CT | ANTHEM BLUE CROSS AND BLU | OTHER |