Provider Demographics
NPI:1003899469
Name:TILVA, PRAFULCHADRA K (MD)
Entity Type:Individual
Prefix:
First Name:PRAFULCHADRA
Middle Name:K
Last Name:TILVA
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:THREE GATEWAY CENTER, 20TH FLOOR
Mailing Address - Street 2:401 LIBERTY AVENUE, SUITE 2000
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15222
Mailing Address - Country:US
Mailing Address - Phone:412-223-2272
Mailing Address - Fax:412-281-6320
Practice Address - Street 1:350 N 11TH ST
Practice Address - Street 2:
Practice Address - City:SUNBURY
Practice Address - State:PA
Practice Address - Zip Code:17801-1611
Practice Address - Country:US
Practice Address - Phone:570-286-3470
Practice Address - Fax:570-286-3397
Is Sole Proprietor?:No
Enumeration Date:2005-11-21
Last Update Date:2008-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD019302E2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0009545200004Medicaid
PAP00427548OtherRAILROAD MEDICARE
PA0009545200008Medicaid
PA0009545200001Medicaid
PA0104798OtherBLUE SHIELD
PA0009545200004Medicaid
PA104798JAMMedicare PIN
PA0104798OtherBLUE SHIELD