Healthcare Provider Details

I. General information

NPI: 1700228384
Provider Name (Legal Business Name): GAURAV NANDA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/23/2013
Last Update Date: 01/09/2021
Certification Date: 01/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4401 PENN AVE RANGOS RESEARCH BLDG, 5TH FLOOR ADMIN 7
PITTSBURGH PA
15224-1334
US

IV. Provider business mailing address

4401 PENN AVE RANGOS RESEARCH BLDG, 5TH FLOOR ADMIN 7
PITTSBURGH PA
15224-1334
US

V. Phone/Fax

Practice location:
  • Phone: 412-692-5574
  • Fax:
Mailing address:
  • Phone: 412-692-5574
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0210X
TaxonomyPediatric Nephrology Physician
License NumberMT203420
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: