Provider Demographics
NPI:1558626440
Name:TAYSHETYE, PRITAM U (MD)
Entity Type:Individual
Prefix:
First Name:PRITAM
Middle Name:U
Last Name:TAYSHETYE
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 1:247 MOREWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15213-1861
Mailing Address - Country:US
Mailing Address - Phone:412-622-0290
Mailing Address - Fax:
Practice Address - Street 1:2508 MYRTLE ST STE 200
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16502-2700
Practice Address - Country:US
Practice Address - Phone:814-452-7822
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-07
Last Update Date:2020-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD462956207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
14281349OtherCAQH