Provider Demographics
NPI:1386069987
Name:NANJAIAH FAMILY PRACTICE INC
Entity type:Organization
Organization Name:NANJAIAH FAMILY PRACTICE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:SUDHARANI
Authorized Official - Middle Name:BANGALORE
Authorized Official - Last Name:NANJAIAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:724-879-4642
Mailing Address - Street 1:433 FRYE FARM RD
Mailing Address - Street 2:SUITE #10
Mailing Address - City:GREENSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15601-7920
Mailing Address - Country:US
Mailing Address - Phone:724-879-4642
Mailing Address - Fax:724-879-8381
Practice Address - Street 1:433 FRYE FARM RD
Practice Address - Street 2:SUITE #10
Practice Address - City:GREENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15601-7920
Practice Address - Country:US
Practice Address - Phone:724-879-4642
Practice Address - Fax:724-879-8381
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-19
Last Update Date:2014-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD434991261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA160882NWBMedicare UPIN