Provider Demographics
NPI:1679563563
Name:MUKHERJEE, KOUSHIK (MD)
Entity type:Individual
Prefix:
First Name:KOUSHIK
Middle Name:
Last Name:MUKHERJEE
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 1:1010 MERIDIAN DR
Mailing Address - Street 2:
Mailing Address - City:PRESTO
Mailing Address - State:PA
Mailing Address - Zip Code:15142-1028
Mailing Address - Country:US
Mailing Address - Phone:412-279-2679
Mailing Address - Fax:412-488-4097
Practice Address - Street 1:100 N BELLEFIELD AVE STE 4T
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15213-2600
Practice Address - Country:US
Practice Address - Phone:412-246-5401
Practice Address - Fax:412-246-5410
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-24
Last Update Date:2021-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD071251L2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA763374OtherHIGHMARK
PA0018044920005Medicaid
PA038078Medicare ID - Type Unspecified
H16315Medicare UPIN