Provider Demographics
NPI:1285755249
Name:MALATHI VENKATESAN, M.D.
Entity type:Organization
Organization Name:MALATHI VENKATESAN, M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MALATHI
Authorized Official - Middle Name:
Authorized Official - Last Name:VENKATESAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:412-322-5777
Mailing Address - Street 1:490 E NORTH AVE
Mailing Address - Street 2:SUITE 204
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15212-4740
Mailing Address - Country:US
Mailing Address - Phone:412-322-5777
Mailing Address - Fax:412-322-5775
Practice Address - Street 1:490 E NORTH AVE
Practice Address - Street 2:SUITE 204
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15212-4740
Practice Address - Country:US
Practice Address - Phone:412-322-5777
Practice Address - Fax:412-322-5775
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD058730-L261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA14517OtherELDERHEALTH
PA1784451OtherUNITED PROVIDER ID
PA01585449Medicaid
PA200195OtherUPMC PROVIDER ID
PA145688OtherUNISON
PA3359545OtherATENA PROVIDER ID
PA6709237003OtherCIGNA PROVIDER ID
PAP000885OtherGATEWAY PROVIDER ID
PA6709237003OtherCIGNA PROVIDER ID
PA14517OtherELDERHEALTH
PA01585449Medicaid