Healthcare Provider Details

I. General information

NPI: 1477536605
Provider Name (Legal Business Name): SESHAIYENGAR VENKATESH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/22/2005
Last Update Date: 02/11/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 DELAFIELD RD SUITE 211
PITTSBURGH PA
15215-3247
US

IV. Provider business mailing address

7075 BENNINGTON WOODS DR
PITTSBURGH PA
15237-6372
US

V. Phone/Fax

Practice location:
  • Phone: 412-784-0666
  • Fax: 412-784-1179
Mailing address:
  • Phone: 412-630-8450
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberMD 058224 L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: