Healthcare Provider Details

I. General information

NPI: 1528613700
Provider Name (Legal Business Name): KEERTHANA GANGADHARAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2019
Last Update Date: 05/22/2025
Certification Date: 05/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 LYTTON AVE STE 201
PITTSBURGH PA
15213-1481
US

IV. Provider business mailing address

3600 FORBES AVE STE 140
PITTSBURGH PA
15213-3410
US

V. Phone/Fax

Practice location:
  • Phone: 412-802-3043
  • Fax:
Mailing address:
  • Phone: 412-647-5815
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberMT233226
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: