Provider Demographics
NPI:1033137542
Name:SRINIVASA, NANGALI S (MD)
Entity Type:Individual
Prefix:
First Name:NANGALI
Middle Name:S
Last Name:SRINIVASA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5171 LIBERTY AVE
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15224-2215
Mailing Address - Country:US
Mailing Address - Phone:412-683-4550
Mailing Address - Fax:412-683-8154
Practice Address - Street 1:5171 LIBERTY AVE
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15224-2215
Practice Address - Country:US
Practice Address - Phone:412-683-4550
Practice Address - Fax:412-683-8154
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2019-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD-049251-L174400000X
PAMD049251L207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA129032601Medicaid
PA129032601Medicaid
PA044927Medicare ID - Type Unspecified