Individual
DR. PURUSHOTHAMA IYENGAR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1051 MORRELL AVE, CONNELLSVILLE, PA 15425-3958
(724) 437-0729
(724) 437-2761
Mailing address
100 NEW SALEM RD, SUITE 116, UNIONTOWN, PA 15401-8936
(724) 437-0729
(724) 437-2761
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
MD-042463-L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0012961880007
—
PA
01
—
322242
MHNET
—
01
—
329-573-0
ECFMG
—
01
—
618489
HIGHMARK
—
Enumeration date
05/05/2006
Last updated
05/09/2017
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