Healthcare Provider Details

I. General information

NPI: 1225128416
Provider Name (Legal Business Name): SRIHARI SRINIVASAN BANGALORE M.D, MPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/16/2006
Last Update Date: 02/11/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

331 SHAW AVE 3RD FLOOR
MCKEESPORT PA
15132-2918
US

IV. Provider business mailing address

1150 GREENFIELD AVE APT # 2
PITTSBURGH PA
15217-2958
US

V. Phone/Fax

Practice location:
  • Phone: 412-675-8855
  • Fax:
Mailing address:
  • Phone: 412-253-7462
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberMD426996
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: