Provider Demographics
NPI:1164725180
Name:MDALA-GAUSI, MASIKU AGATHA (MD)
Entity Type:Individual
Prefix:DR
First Name:MASIKU
Middle Name:AGATHA
Last Name:MDALA-GAUSI
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 1:12351 PERRY HWY
Mailing Address - Street 2:
Mailing Address - City:WEXFORD
Mailing Address - State:PA
Mailing Address - Zip Code:15090-8344
Mailing Address - Country:US
Mailing Address - Phone:412-359-3030
Mailing Address - Fax:412-359-3060
Practice Address - Street 1:12351 PERRY HWY
Practice Address - Street 2:
Practice Address - City:WEXFORD
Practice Address - State:PA
Practice Address - Zip Code:15090-8344
Practice Address - Country:US
Practice Address - Phone:412-359-3030
Practice Address - Fax:412-359-3060
Is Sole Proprietor?:No
Enumeration Date:2010-12-14
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2013-01270208M00000X
PAMD479811208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCNCC657AMedicare PIN