Healthcare Provider Details

I. General information

NPI: 1275525149
Provider Name (Legal Business Name): NAGAMANI KASI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2005
Last Update Date: 10/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3542 BRODHEAD RD
MONACA PA
15061-3126
US

IV. Provider business mailing address

3542 BRODHEAD RD
MONACA PA
15061-3126
US

V. Phone/Fax

Practice location:
  • Phone: 724-775-9919
  • Fax: 724-775-6922
Mailing address:
  • Phone: 724-775-9919
  • Fax: 724-775-6922

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD039315L
License Number StatePA

VII. Legacy identifiers

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

# 1
Identifier1411323
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: