Healthcare Provider Details

I. General information

NPI: 1962631051
Provider Name (Legal Business Name): SANTOSH J. BHUSAL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2009
Last Update Date: 12/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

580 S AIKEN AVE SUITE 430
PITTSBURGH PA
15232-1531
US

IV. Provider business mailing address

2 HOT METAL ST QUANTUM ONE, SUITE 001
PITTSBURGH PA
15203-2348
US

V. Phone/Fax

Practice location:
  • Phone: 412-682-2434
  • Fax: 412-682-1044
Mailing address:
  • Phone: 412-647-3087
  • Fax: 412-432-5640

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number57-015946
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD446214
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: