Provider Demographics
NPI:1306838065
Name:CHENGAPPA, PALECANDA P (MD)
Entity Type:Individual
Prefix:DR
First Name:PALECANDA
Middle Name:P
Last Name:CHENGAPPA
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 1:2100 JANE ST
Mailing Address - Street 2:ROESCH-TAYLOR MEDICAL BUILDING SUITE 801
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15203-2065
Mailing Address - Country:US
Mailing Address - Phone:412-381-2620
Mailing Address - Fax:412-381-6322
Practice Address - Street 1:2100 JANE ST
Practice Address - Street 2:ROESCH-TAYLOR MEDICAL BUILDING SUITE 801
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15203-2065
Practice Address - Country:US
Practice Address - Phone:412-381-2620
Practice Address - Fax:412-381-6322
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-18
Last Update Date:2008-03-19
Deactivation Date:2006-04-10
Deactivation Code:
Reactivation Date:2006-04-11
Provider Licenses
StateLicense IDTaxonomies
PAMD026603E207R00000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0010079730002Medicaid
PA0010079730002Medicaid
PAA83654Medicare UPIN
PA0060003975Medicare NSC