Provider Demographics
NPI:1467633057
Name:SARDESAI, MAHESH PRABHAKER (MD)
Entity Type:Individual
Prefix:DR
First Name:MAHESH
Middle Name:PRABHAKER
Last Name:SARDESAI
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 1:5230 CENTRE AVE
Mailing Address - Street 2:SUITE 205
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15232-1304
Mailing Address - Country:US
Mailing Address - Phone:412-623-2163
Mailing Address - Fax:412-623-0047
Practice Address - Street 1:5230 CENTRE AVE
Practice Address - Street 2:SUITE 205
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15232-1304
Practice Address - Country:US
Practice Address - Phone:412-623-2163
Practice Address - Fax:412-623-0047
Is Sole Proprietor?:No
Enumeration Date:2007-11-25
Last Update Date:2016-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-116004207L00000X
KY42940207L00000X
PAMD443008207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100071780Medicaid
KY7100071780Medicaid
KYP00750261Medicare PIN