Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RC0000X | Internist - Cardiovascular Disease | MD438934 | PA |
Y | 207RI0011X | Interventional Cardiology | MD438934 | PA |
NPI | 1053606707 |
---|---|
Provider Name | Mithun Chakravarthy |
First Address | Pittsburgh, PA 15212-4740 |
Second Address | Pittsburgh, PA 15212-4740 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/06/2011 |
Last Update Date | 06/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1026053420001 | (05) | PA |
3158998 | (05) | OH |
3810021344 | (05) | WV |