Provider Demographics
NPI:1548848427
Name:PERUMBALA, KRISHNAN
Entity type:Individual
Prefix:
First Name:KRISHNAN
Middle Name:
Last Name:PERUMBALA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3600 FORBES AVENUE
Mailing Address - Street 2:FORBES TOWER - PLAZA LEVEL SUITE 140
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15213
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1400 LOCUST STREET
Practice Address - Street 2:BUILDING B, ROOM 9520
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15219
Practice Address - Country:US
Practice Address - Phone:412-232-5515
Practice Address - Fax:412-232-5529
Is Sole Proprietor?:No
Enumeration Date:2021-03-31
Last Update Date:2024-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
PASC007192213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program