Provider Demographics
NPI:1184640203
Name:KSHIRSAGAR, ASHUTOSH V (MD)
Entity Type:Individual
Prefix:
First Name:ASHUTOSH
Middle Name:V
Last Name:KSHIRSAGAR
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 1:935 THORN RUN RD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:MOON TWP
Mailing Address - State:PA
Mailing Address - Zip Code:15108-2861
Mailing Address - Country:US
Mailing Address - Phone:412-299-8550
Mailing Address - Fax:412-299-8922
Practice Address - Street 1:935 THORN RUN RD
Practice Address - Street 2:SUITE 210
Practice Address - City:MOON TWP
Practice Address - State:PA
Practice Address - Zip Code:15108-2861
Practice Address - Country:US
Practice Address - Phone:412-299-8550
Practice Address - Fax:412-299-8922
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101239960208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAMD445740OtherMEDICAL LICENSE
MDD0063590OtherSTATE LICENSE
VA0101239960OtherSTATE MEDICAL LICENSE
PA102847272Medicaid
PA102847272Medicaid
VA0101239960OtherSTATE MEDICAL LICENSE
PA102847272Medicaid
PAMD445740OtherMEDICAL LICENSE