Provider Demographics
NPI:1255480398
Name:ATHANI, VIJAY SATAPPA (MD)
Entity Type:Individual
Prefix:
First Name:VIJAY
Middle Name:SATAPPA
Last Name:ATHANI
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 1:1200 BROOKS LN
Mailing Address - Street 2:SUITE 220
Mailing Address - City:CLAIRTON
Mailing Address - State:PA
Mailing Address - Zip Code:15025-3747
Mailing Address - Country:US
Mailing Address - Phone:412-469-1002
Mailing Address - Fax:412-469-8925
Practice Address - Street 1:1200 BROOKS LN
Practice Address - Street 2:SUITE 220
Practice Address - City:CLAIRTON
Practice Address - State:PA
Practice Address - Zip Code:15025-3747
Practice Address - Country:US
Practice Address - Phone:412-469-1002
Practice Address - Fax:412-469-8925
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2020-10-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD020248E208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0006814310003Medicaid
PAB41214Medicare UPIN
PA0006814310003Medicaid