Provider Demographics
NPI:1174814271
Name:MORISETTY MEDICAL ASSOCIATES, INC.
Entity Type:Organization
Organization Name:MORISETTY MEDICAL ASSOCIATES, INC.
Other - Org Name:CARES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SATYASGAR
Authorized Official - Middle Name:
Authorized Official - Last Name:MORISETTY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:330-758-2775
Mailing Address - Street 1:PO BOX 14397
Mailing Address - Street 2:
Mailing Address - City:POLAND
Mailing Address - State:OH
Mailing Address - Zip Code:44514-7397
Mailing Address - Country:US
Mailing Address - Phone:330-758-2775
Mailing Address - Fax:330-758-2787
Practice Address - Street 1:1 ROSS PARK BLVD STE G-3
Practice Address - Street 2:
Practice Address - City:STEUBENVILLE
Practice Address - State:OH
Practice Address - Zip Code:43952-2681
Practice Address - Country:US
Practice Address - Phone:740-314-5819
Practice Address - Fax:740-314-5814
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-22
Last Update Date:2011-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV21439207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH35062048MOtherMEDICAL LICENSE
PAMD421673OtherMEDICAL LICENSE