Provider Demographics
NPI:1275523763
Name:KOMANDURI, VENKATA ANAND (MD)
Entity Type:Individual
Prefix:DR
First Name:VENKATA
Middle Name:ANAND
Last Name:KOMANDURI
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 1:1501 REEDSDALE ST
Mailing Address - Street 2:SUITE 4004
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15233-2341
Mailing Address - Country:US
Mailing Address - Phone:412-204-0048
Mailing Address - Fax:412-363-5575
Practice Address - Street 1:1501 REEDSDALE ST STE 4004
Practice Address - Street 2:WPAA
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15233-2317
Practice Address - Country:US
Practice Address - Phone:412-204-0048
Practice Address - Fax:412-363-5575
Is Sole Proprietor?:No
Enumeration Date:2005-10-26
Last Update Date:2010-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA213391207L00000X
PAMD441087207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAA34322Medicare PIN
MAH65863Medicare UPIN