Provider Demographics
NPI:1902250780
Name:HUNDIE, GIRMA GUTEMA (PHYSICIAN ASSISTANCE)
Entity Type:Individual
Prefix:
First Name:GIRMA
Middle Name:GUTEMA
Last Name:HUNDIE
Suffix:
Gender:M
Credentials:PHYSICIAN ASSISTANCE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:431 WILSON DR
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15235-1741
Mailing Address - Country:US
Mailing Address - Phone:864-546-0421
Mailing Address - Fax:
Practice Address - Street 1:431 WILSON DRIVE
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15235
Practice Address - Country:US
Practice Address - Phone:864-546-0421
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-19
Last Update Date:2016-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA058173363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical