=====================================================
General NPI Number Information
=====================================================
NPI Number | 1407827629
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | VASANTHA C. MADHAVAN M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/27/2006
-----------------------------------------------------
Last Update Date | 06/28/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 21 YOST BLVD FOREST HILLS PLAZA-SUITE 216
-----------------------------------------------------
City | PITTSBURGH
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15221-5283
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 412-823-3113
-----------------------------------------------------
Fax | 412-824-8634
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 21 YOST BLVD FOREST HILLS PLAZA-SUITE 216
-----------------------------------------------------
City | PITTSBURGH
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15221-5283
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 412-823-3113
-----------------------------------------------------
Fax | 412-824-8634
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RC0000X
-----------------------------------------------------
Taxonomy Name | Cardiovascular Disease Physician
-----------------------------------------------------
License Number | MD027285E
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------