Provider Demographics
NPI:1033422969
Name:GOLLA CENTER FOR PLASTIC SURGERY, P.C.
Entity Type:Organization
Organization Name:GOLLA CENTER FOR PLASTIC SURGERY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DINAKAR
Authorized Official - Middle Name:
Authorized Official - Last Name:GOLLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:412-963-6677
Mailing Address - Street 1:107 GAMMA DR
Mailing Address - Street 2:SUITE 210
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15238-2917
Mailing Address - Country:US
Mailing Address - Phone:412-963-6677
Mailing Address - Fax:412-963-6868
Practice Address - Street 1:107 GAMMA DR
Practice Address - Street 2:SUITE 210
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15238-2917
Practice Address - Country:US
Practice Address - Phone:412-963-6677
Practice Address - Fax:412-963-6868
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-20
Last Update Date:2016-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD4245422086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1014932050002Medicaid
PA7540010001Medicare NSC
PA105611Medicare UPIN
078739FKYMedicare PIN