MEDICARE: KUMARESAN GANABATHI M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208800000X	Urology Physician	MD053586L	PA

General Provider Information

NPI Number	:	1437125986
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KUMARESAN GANABATHI M.D.

Provider Business Mailing Address
First Line	:	100 HOSPITAL AVE
Second Line	:
City	:	DU BOIS
State	:	PA
Zip	:	15801-1440
Country	:	US
Telephone Number	:	814-849-8858
Fax Number	:

Provider Business Practice Location Address
First Line	:	240 ALLEGHENY BLVD
Second Line	:	SUITE J
City	:	BROOKVILLE
State	:	PA
Zip	:	15825-2323
Country	:	US
Telephone Number	:	814-849-8858
Fax Number	:	814-849-3741

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/24/2006
Last Update Date	:	06/12/2019

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