MEDICARE: DR. SHAN GAO 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	390200000X	Student in an Organized Health Care Education/Training Program
2	2084P0804X	Child & Adolescent Psychiatry Physician	MD465316	PA

General Provider Information

NPI Number	:	1740675214
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHAN GAO MD

Provider Business Mailing Address
First Line	:	322 N SHORE DR STE 200
Second Line	:
City	:	PITTSBURGH
State	:	PA
Zip	:	15212-5875
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	322 N SHORE DR STE 200
Second Line	:
City	:	PITTSBURGH
State	:	PA
Zip	:	15212-5875
Country	:	US
Telephone Number	:	412-213-8855
Fax Number	:

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

Provider Enumeration Date	:	04/01/2015
Last Update Date	:	09/05/2024

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