Healthcare Provider Details

I. General information

NPI: 1003047242
Provider Name (Legal Business Name): KRISHNA KANCHARLA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2009
Last Update Date: 03/25/2021
Certification Date: 08/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5200 CENTRE AVE SUITE 710
PITTSBURGH PA
15232-1300
US

IV. Provider business mailing address

200 LOTHROP STREET PUH G304
PITTSBURGH PA
15213-2546
US

V. Phone/Fax

Practice location:
  • Phone: 412-623-6889
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License NumberMD461265
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: