Provider Demographics
NPI:1518939065
Name:CHANNARASAPPA, ANUPAMA S (MD)
Entity Type:Individual
Prefix:DR
First Name:ANUPAMA
Middle Name:S
Last Name:CHANNARASAPPA
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:SUITE 201, ONE ALEXANDER CENTER
Mailing Address - Street 2:2585 FREEPORT ROAD
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15238
Mailing Address - Country:US
Mailing Address - Phone:412-826-8840
Mailing Address - Fax:
Practice Address - Street 1:SUITE 201, ONE ALEXANDER CENTER
Practice Address - Street 2:2585 FREEPORT ROAD
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15238
Practice Address - Country:US
Practice Address - Phone:412-826-8840
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD056428L174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAG11821Medicare UPIN
PA790398PEBMedicare ID - Type Unspecified