Provider Demographics
NPI:1780657544
Name:KANAKAMEDALA, SATISH BABU (MD)
Entity Type:Individual
Prefix:DR
First Name:SATISH
Middle Name:BABU
Last Name:KANAKAMEDALA
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 1:4318 NORTHERN PIKE STE 203
Mailing Address - Street 2:
Mailing Address - City:MONROEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15146-2846
Mailing Address - Country:US
Mailing Address - Phone:412-683-2488
Mailing Address - Fax:412-683-4420
Practice Address - Street 1:4318 NORTHERN PIKE STE 203
Practice Address - Street 2:
Practice Address - City:MONROEVILLE
Practice Address - State:PA
Practice Address - Zip Code:15146-2846
Practice Address - Country:US
Practice Address - Phone:412-683-2488
Practice Address - Fax:412-683-4420
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-10
Last Update Date:2023-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD47704L174400000X
PAMD047704L207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0000004793OtherBLUE SHIELD
PA0014251780005Medicaid
10723709OtherCAQH
PA004793Medicare ID - Type Unspecified