Provider Demographics
NPI:1164459699
Name:GOWDA, ANURADHA (MD)
Entity Type:Individual
Prefix:DR
First Name:ANURADHA
Middle Name:
Last Name:GOWDA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11618 FRANKSTOWN RD
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15235-3319
Mailing Address - Country:US
Mailing Address - Phone:412-731-7170
Mailing Address - Fax:412-731-7172
Practice Address - Street 1:11618 FRANKSTOWN RD
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15235-3319
Practice Address - Country:US
Practice Address - Phone:412-731-7170
Practice Address - Fax:412-731-7172
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA060383L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01621760Medicaid
PAG46612Medicare UPIN
PA01621760Medicaid