Basic Information
| Provider Information | |||||||||
| NPI: | 1033137542 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SRINIVASA | ||||||||
| FirstName: | NANGALI | ||||||||
| MiddleName: | S | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5171 LIBERTY AVE | ||||||||
| Address2: | |||||||||
| City: | PITTSBURGH | ||||||||
| State: | PA | ||||||||
| PostalCode: | 152242215 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4126834550 | ||||||||
| FaxNumber: | 4126838154 | ||||||||
| Practice Location | |||||||||
| Address1: | 5171 LIBERTY AVE | ||||||||
| Address2: | |||||||||
| City: | PITTSBURGH | ||||||||
| State: | PA | ||||||||
| PostalCode: | 152242215 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4126834550 | ||||||||
| FaxNumber: | 4126838154 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/17/2006 | ||||||||
| LastUpdateDate: | 06/17/2019 | ||||||||
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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 | 174400000X | MD-049251-L | PA | N | Other Service Providers | Specialist | 207RN0300X | MD049251L | PA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology |
ID Information
| ID | Type | State | Issuer | Description | 129032601 | 05 | PA | MEDICAID |