1972678233 NPI number — BRUCE J NOTHMANN MD & SUDHIR K NARLA MD PC

Table of content: (NPI 1972678233)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972678233 NPI number — BRUCE J NOTHMANN MD & SUDHIR K NARLA MD PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BRUCE J NOTHMANN MD & SUDHIR K NARLA MD PC
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:
Provider Other Organization Name Type Code:
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:
1972678233
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/15/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1320 FIFTH AVENUE
Provider Second Line Business Mailing Address:
SUITE A
Provider Business Mailing Address City Name:
MCKEESPORT
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15132
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
412-672-5766
Provider Business Mailing Address Fax Number:
412-672-8113

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1320 FIFTH AVENUE
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
MCKEESPORT
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15132
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
412-672-5766
Provider Business Practice Location Address Fax Number:
412-672-8113
Provider Enumeration Date:
11/22/2006

Additional Information

Authorized Official

Authorized Official Last Name:
NARLA
Authorized Official First Name:
SUDHIR
Authorized Official Middle Name:
K
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
412-672-5766

Provider Taxonomy Codes

  • Taxonomy code: 207RG0100X , with the licence number:  MD015084E , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207RG0100X , with the licence number: MD038033L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 0880990 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0008849260001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 064199I , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 196434 . This is a "HIGHMARK BLUE CROSS SHIEL" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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