1255507109 NPI number — CHANDRASEKHAR GOLLA MD

Table of content: (NPI 1255507109)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255507109 NPI number — CHANDRASEKHAR GOLLA MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHANDRASEKHAR GOLLA MD
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
MCKNIGHT MEDICAL CENTER
Provider Other Organization Name Type Code:
5
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1255507109
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/25/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9401 MCKNIGHT RD
Provider Second Line Business Mailing Address:
SUITE 302
Provider Business Mailing Address City Name:
PITTSBURGH
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15237-6000
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
412-364-0333
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9401 MCKNIGHT RD
Provider Second Line Business Practice Location Address:
SUITE 302
Provider Business Practice Location Address City Name:
PITTSBURGH
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15237-6000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
412-364-0333
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/01/2008

Additional Information

Authorized Official

Authorized Official Last Name:
GOLLA
Authorized Official First Name:
CHANDRASEKHAR
Authorized Official Middle Name:
Authorized Official Title or Position:
MD SOLE PROPRIETOR
Authorized Official Telephone Number:
412-364-0333

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  MD0386611L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0006812260003 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 441726 . This is a "BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com