Provider Demographics
NPI:1326018920
Name:BANSAL, PRABHA (MD)
Entity Type:Individual
Prefix:
First Name:PRABHA
Middle Name:
Last Name:BANSAL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 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:412-432-5806
Mailing Address - Fax:412-432-7691
Practice Address - Street 1:1604 BURTNER RD
Practice Address - Street 2:
Practice Address - City:NATRONA HEIGHTS
Practice Address - State:PA
Practice Address - Zip Code:15065-2845
Practice Address - Country:US
Practice Address - Phone:724-230-3030
Practice Address - Fax:724-230-3001
Is Sole Proprietor?:No
Enumeration Date:2006-01-25
Last Update Date:2009-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD035706L2085R0203X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0203XAllopathic & Osteopathic PhysiciansRadiologyTherapeutic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0006584510009Medicaid
PA0006584510010Medicaid
WV0117359000Medicaid
PA0006584510006Medicaid
PA0006584510007Medicaid
PA0006584510012Medicaid
PA0006584510013Medicaid
PA0006584510014Medicaid
PA0006584510008Medicaid
OH0479692Medicaid
PA102375OtherHIGHMARK BS
PA0006584510011Medicaid
PA11320212OtherCAQH
PA0006584510005Medicaid
PA0006584510015Medicaid
PA0006584510013Medicaid
PA0006584510014Medicaid
PAB36469Medicare UPIN
PA0006584510011Medicaid
OH0479692Medicaid
PAP00446195Medicare PIN
PAP00412849Medicare PIN
PA0006584510007Medicaid
PA0006584510006Medicaid
PAP00281981Medicare PIN