Provider Demographics
NPI:1245200138
Name:BAHRI, SANJEEV
Entity Type:Individual
Prefix:
First Name:SANJEEV
Middle Name:
Last Name:BAHRI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 HOT METAL ST
Mailing Address - Street 2:QUANTUM ONE N431
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15203-2348
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:200 VILLAGE DR
Practice Address - Street 2:
Practice Address - City:GREENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15601-3783
Practice Address - Country:US
Practice Address - Phone:724-838-1900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-24
Last Update Date:2021-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD055413L2085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0015454250002Medicaid
PA0015454250009Medicaid
PA805980OtherHIGHMARK BS
PA10788069OtherCAQH
PA00015454250013Medicaid
PA0015454250002Medicaid
PA00015454250013Medicaid
PA0015454250009Medicaid
PA920007498Medicare PIN
PA805980RJCMedicare PIN
PA920007563Medicare PIN
PA805980QEHMedicare PIN