Provider Demographics
NPI:1043258403
Name:VICHARE, KAWITA (MD)
Entity Type:Individual
Prefix:DR
First Name:KAWITA
Middle Name:
Last Name:VICHARE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:532 S AIKEN AVE
Mailing Address - Street 2:SUITE #201
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15232-1521
Mailing Address - Country:US
Mailing Address - Phone:412-621-6166
Mailing Address - Fax:888-421-2768
Practice Address - Street 1:532 S AIKEN AVE
Practice Address - Street 2:SUITE #201
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15232-1521
Practice Address - Country:US
Practice Address - Phone:412-621-6166
Practice Address - Fax:888-421-2768
Is Sole Proprietor?:No
Enumeration Date:2006-06-04
Last Update Date:2012-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD424785207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAVI1860299OtherHIGHMARK BCBS
PA102300377 0001Medicaid
PA100304VEMMedicare PIN