Provider Demographics
NPI:1245350503
Name:S. VENKATESH MD PC
Entity type:Organization
Organization Name:S. VENKATESH MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SESHARYENGAR
Authorized Official - Middle Name:
Authorized Official - Last Name:VENKATESH
Authorized Official - Suffix:
Authorized Official - Credentials:MD PC
Authorized Official - Phone:412-784-0666
Mailing Address - Street 1:7075 BENNINGTON WOODS DR
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15237-6372
Mailing Address - Country:US
Mailing Address - Phone:412-784-0666
Mailing Address - Fax:412-784-1179
Practice Address - Street 1:100 DELAFIELD RD STE 211
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15215-3247
Practice Address - Country:US
Practice Address - Phone:412-784-0666
Practice Address - Fax:412-784-1179
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-30
Last Update Date:2009-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA058224L152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1583481OtherBLUE SHIELD
PA698321Medicare ID - Type UnspecifiedMEDICARE
PA1583481OtherBLUE SHIELD