MEDICARE: SURANDRA K BANSAL MD

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	2085R0202X	Diagnostic Radiology Physician	MD031913L	PA

General Provider Information

NPI Number	:	1639176761
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SURANDRA K BANSAL MD

Provider Business Mailing Address
First Line	:	200 LOTHROP ST
Second Line	:	SUITE 9055 FORBES TOWER
City	:	PITTSBURGH
State	:	PA
Zip	:	15213-2536
Country	:	US
Telephone Number	:	412-647-0943
Fax Number	:	412-647-4050

Provider Business Practice Location Address
First Line	:	1400 LOCUST ST
Second Line	:
City	:	PITTSBURGH
State	:	PA
Zip	:	15219-5114
Country	:	US
Telephone Number	:	412-232-7909
Fax Number	:	412-232-5502

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

Provider Enumeration Date	:	07/05/2005
Last Update Date	:	11/12/2007

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