Provider Demographics
NPI:1811903271
Name:GANTI, MURTY S (MD)
Entity type:Individual
Prefix:DR
First Name:MURTY
Middle Name:S
Last Name:GANTI
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 1:395 GLENWOOD DR
Mailing Address - Street 2:
Mailing Address - City:MONROEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15146-1837
Mailing Address - Country:US
Mailing Address - Phone:412-666-0394
Mailing Address - Fax:
Practice Address - Street 1:600 JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:JEANNETTE
Practice Address - State:PA
Practice Address - Zip Code:15644-2539
Practice Address - Country:US
Practice Address - Phone:724-527-9300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD 044901-L207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAC59101Medicare UPIN