1710168323 NPI number — SHERU K KANSAL MD

Table of content: SHERU K KANSAL MD (NPI 1710168323)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710168323 NPI number — SHERU K KANSAL MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KANSAL
Provider First Name:
SHERU
Provider Middle Name:
K
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1710168323
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/03/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3824 NORTHERN PIKE
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
MONROEVILLE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15146
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
412-457-0060
Provider Business Mailing Address Fax Number:
412-457-0092

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2570 HAYMAKER ROAD
Provider Second Line Business Practice Location Address:
FORBES REGIONAL HOSPITAL
Provider Business Practice Location Address City Name:
MONROEVILLE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15146
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
412-858-7618
Provider Business Practice Location Address Fax Number:
412-858-7628
Provider Enumeration Date:
11/26/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  MD432432 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208M00000X , with the licence number: MD432432 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RN0300X , with the licence number: 35.094825 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1020598600001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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