Provider Demographics
NPI:1528046570
Name:MENON, MADHUSUDAN (MD)
Entity type:Individual
Prefix:
First Name:MADHUSUDAN
Middle Name:
Last Name:MENON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:810 CLAIRTON BLVD STE 400
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15236-4519
Mailing Address - Country:US
Mailing Address - Phone:412-650-1150
Mailing Address - Fax:412-650-1151
Practice Address - Street 1:810 CLAIRTON BLVD STE 400
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15236-4519
Practice Address - Country:US
Practice Address - Phone:412-650-1150
Practice Address - Fax:412-650-1151
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-09
Last Update Date:2020-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD 071115 L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H23383Medicare UPIN
PA041625QTTMedicare ID - Type Unspecified