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General NPI Number Information
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NPI Number | 1386069987
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Entity Type | Organization
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Legal Business Name | NANJAIAH FAMILY PRACTICE INC
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Dates
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Enumeration Date | 02/19/2014
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Last Update Date | 02/19/2014
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Provider Practice Location Address
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Address Line | 433 FRYE FARM RD SUITE #10
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City | GREENSBURG
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State | PA
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Zip | 15601-7920
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Country | US
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Telephone | 724-879-4642
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Fax | 724-879-8381
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Provider Business Mailing Address
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Address Line | 433 FRYE FARM RD SUITE #10
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City | GREENSBURG
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State | PA
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Zip | 15601-7920
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Country | US
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Telephone | 724-879-4642
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Fax | 724-879-8381
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. SUDHARANI BANGALORE NANJAIAH
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Credential | M.D.
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Telephone | 724-879-4642
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | MD434991
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License Number State | PA
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