Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | MD437712 | PA |
Y | 207QG0300X | Family Doctor - Geriatric Medicine | MD437712 | PA |
NPI | 1326246117 |
---|---|
Provider Name | Sumana Bangalore |
First Address | Pittsburgh, PA 15224-1779 |
Second Address | Pittsburgh, PA 15224-1779 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/07/2007 |
Last Update Date | 17/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
102317795 | (05) | PA |