Provider Demographics
NPI:1699771527
Name:MORISETTY, SATYASAGAR (MD)
Entity type:Individual
Prefix:
First Name:SATYASAGAR
Middle Name:
Last Name:MORISETTY
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 1:2100 MACK BLVD FL 4
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18103-5622
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1250 S CEDAR CREST BLVD STE 205
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18103-6271
Practice Address - Country:US
Practice Address - Phone:610-402-9116
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-24
Last Update Date:2025-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV21439207RP1001X
OH35062048M207RP1001X
NY186554-1207RP1001X
NJ55696207RP1001X
PAMD421673207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHP00121410OtherRR MEDICARE
PA1012108920001Medicaid
WV3000305000Medicaid
OH2487456Medicaid
WVP00437973OtherRR MEDICARE
WVP00437973OtherRR MEDICARE
F09978Medicare UPIN
OH2487456Medicaid
OH4126691Medicare PIN
OHP00121410OtherRR MEDICARE
WV4126695Medicare PIN
WV4126694Medicare PIN
OH4126693Medicare PIN