Provider Demographics
NPI:1205965316
Name:K.M. PHANSE, M.D.
Entity type:Organization
Organization Name:K.M. PHANSE, M.D.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:MS
Authorized Official - First Name:KALYANI
Authorized Official - Middle Name:M
Authorized Official - Last Name:PHANSE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:724-941-1100
Mailing Address - Street 1:4000 WATERDAM PLAZA DR
Mailing Address - Street 2:SUITE 280
Mailing Address - City:MCMURRAY
Mailing Address - State:PA
Mailing Address - Zip Code:15317-2494
Mailing Address - Country:US
Mailing Address - Phone:724-941-1100
Mailing Address - Fax:724-941-0190
Practice Address - Street 1:4000 WATERDAM PLAZA DR
Practice Address - Street 2:SUITE 280
Practice Address - City:MCMURRAY
Practice Address - State:PA
Practice Address - Zip Code:15317-2494
Practice Address - Country:US
Practice Address - Phone:724-941-1100
Practice Address - Fax:724-941-0190
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD034854L207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Multi-Specialty