Provider Demographics
NPI:1285626457
Name:KASI, KRISHNA K (MD)
Entity Type:Individual
Prefix:
First Name:KRISHNA
Middle Name:K
Last Name:KASI
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 1:3542 BRODHEAD RD
Mailing Address - Street 2:
Mailing Address - City:MONACA
Mailing Address - State:PA
Mailing Address - Zip Code:15061-3126
Mailing Address - Country:US
Mailing Address - Phone:724-775-9919
Mailing Address - Fax:724-775-6922
Practice Address - Street 1:3542 BRODHEAD RD
Practice Address - Street 2:
Practice Address - City:MONACA
Practice Address - State:PA
Practice Address - Zip Code:15061-3126
Practice Address - Country:US
Practice Address - Phone:724-775-9919
Practice Address - Fax:724-775-6922
Is Sole Proprietor?:No
Enumeration Date:2005-08-16
Last Update Date:2015-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD038961L208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA00800130Medicaid
PA132956Medicare ID - Type Unspecified
PA00800130Medicaid