1285755249 NPI number — MALATHI VENKATESAN, M.D.

Table of content: (NPI 1285755249)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285755249 NPI number — MALATHI VENKATESAN, M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MALATHI VENKATESAN, M.D.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1285755249
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
490 E NORTH AVE
Provider Second Line Business Mailing Address:
SUITE 204
Provider Business Mailing Address City Name:
PITTSBURGH
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15212-4740
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
412-322-5777
Provider Business Mailing Address Fax Number:
412-322-5775

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
490 E NORTH AVE
Provider Second Line Business Practice Location Address:
SUITE 204
Provider Business Practice Location Address City Name:
PITTSBURGH
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15212-4740
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
412-322-5777
Provider Business Practice Location Address Fax Number:
412-322-5775
Provider Enumeration Date:
04/03/2007

Additional Information

Authorized Official

Authorized Official Last Name:
VENKATESAN
Authorized Official First Name:
MALATHI
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
412-322-5777

Provider Taxonomy Codes

  • Taxonomy code: 261QP2300X , with the licence number:  MD058730-L , 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: 14517 . This is a "ELDERHEALTH" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1784451 . This is a "UNITED PROVIDER ID" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 01585449 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200195 . This is a "UPMC PROVIDER ID" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 145688 . This is a "UNISON" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 3359545 . This is a "ATENA PROVIDER ID" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 6709237003 . This is a "CIGNA PROVIDER ID" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: P000885 . This is a "GATEWAY PROVIDER ID" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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