Healthcare Provider Details

I. General information

NPI: 1750598975
Provider Name (Legal Business Name): VEENA VENKAT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2007
Last Update Date: 05/24/2021
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3705 5TH AVE THIRD FLOOR
PITTSBURGH PA
15213-2584
US

IV. Provider business mailing address

3705 5TH AVE THIRD FLOOR
PITTSBURGH PA
15213-2584
US

V. Phone/Fax

Practice location:
  • Phone: 412-692-5180
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0206X
TaxonomyPediatric Gastroenterology Physician
License NumberMD430913
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: