Provider Demographics
NPI:1730174368
Name:GOLLA, CHANDRASEKHAR (MD)
Entity type:Individual
Prefix:
First Name:CHANDRASEKHAR
Middle Name:
Last Name:GOLLA
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 1:5000 MCKNIGHT RD
Mailing Address - Street 2:SUITE 406
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15237-3420
Mailing Address - Country:US
Mailing Address - Phone:412-364-0333
Mailing Address - Fax:412-364-1856
Practice Address - Street 1:5000 MCKNIGHT RD
Practice Address - Street 2:SUITE 406
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15237-3420
Practice Address - Country:US
Practice Address - Phone:412-364-0333
Practice Address - Fax:412-364-1856
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-20
Last Update Date:2008-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD038611-L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0006812260003Medicaid
PA0006812260003Medicaid
B40051Medicare UPIN