Healthcare Provider Details

I. General information

NPI: 1902859424
Provider Name (Legal Business Name): NISANTHA M BANDARANAYAKE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9100 BABCOCK BLVD
PITTSBURGH PA
15237-5815
US

IV. Provider business mailing address

9100 BABCOCK BLVD
PITTSBURGH PA
15237-5815
US

V. Phone/Fax

Practice location:
  • Phone: 412-367-6700
  • Fax:
Mailing address:
  • Phone: 412-367-6700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberMD035911L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: