Provider Demographics
NPI:1396903613
Name:SANIKOMMU, VIJAYA BHARATHI (MD)
Entity type:Individual
Prefix:
First Name:VIJAYA
Middle Name:BHARATHI
Last Name:SANIKOMMU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:VIJAYA
Other - Middle Name:BHARATHI
Other - Last Name:GAJJALA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:490 E NORTH AVE STE 307
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15212-4740
Mailing Address - Country:US
Mailing Address - Phone:412-359-5822
Mailing Address - Fax:412-359-6620
Practice Address - Street 1:490 E NORTH AVE STE 307
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15212-4740
Practice Address - Country:US
Practice Address - Phone:412-359-5822
Practice Address - Fax:412-359-6620
Is Sole Proprietor?:No
Enumeration Date:2008-05-23
Last Update Date:2020-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD427987207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1021870550001Medicaid
WV3810012737Medicaid
OH2863147Medicaid
WV3810012737Medicaid