1033355912 NPI number — SANGEETA LAKSHMI KOMERALLY M.D

Table of content: SANGEETA LAKSHMI KOMERALLY M.D (NPI 1033355912)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033355912 NPI number — SANGEETA LAKSHMI KOMERALLY M.D

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KOMERALLY
Provider First Name:
SANGEETA
Provider Middle Name:
LAKSHMI
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D
Provider Gender Code:
F

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:
1033355912
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/05/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3824 NORTHERN PIKE STE 700
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MONROEVILLE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15146-2184
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
412-457-0060
Provider Business Mailing Address Fax Number:
412-457-0067

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2570 HAYMAKER RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MONROEVILLE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15146-3513
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:
12/26/2008

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:  MD437503 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 102338955 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".