Healthcare Provider Details

I. General information

NPI: 1184640203
Provider Name (Legal Business Name): ASHUTOSH V KSHIRSAGAR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

935 THORN RUN RD SUITE 210
MOON TWP PA
15108-2861
US

IV. Provider business mailing address

935 THORN RUN RD SUITE 210
MOON TWP PA
15108-2861
US

V. Phone/Fax

Practice location:
  • Phone: 412-299-8550
  • Fax: 412-299-8922
Mailing address:
  • Phone: 412-299-8550
  • Fax: 412-299-8922

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number0101239960
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: