Provider Demographics
NPI:1114025558
Name:AMIRNENI, SATISH (MD)
Entity Type:Individual
Prefix:
First Name:SATISH
Middle Name:
Last Name:AMIRNENI
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 1:114 HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:HOLLIDAYSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:16648-9740
Mailing Address - Country:US
Mailing Address - Phone:814-696-5790
Mailing Address - Fax:814-696-5790
Practice Address - Street 1:809 TURNPIKE AVE
Practice Address - Street 2:C/O BRIGHT HORIZONS(CLEARFIELD HOSPITAL)
Practice Address - City:CLEARFIELD
Practice Address - State:PA
Practice Address - Zip Code:16830-1232
Practice Address - Country:US
Practice Address - Phone:814-768-2184
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2010-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD054618-L2084P0805X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA015282000006Medicaid
PA260048013OtherRAILROAD MEDICARE
PA260048013OtherRAILROAD MEDICARE
PA522989Medicare ID - Type Unspecified