Provider Demographics
NPI:1255507109
Name:CHANDRASEKHAR GOLLA MD
Entity Type:Organization
Organization Name:CHANDRASEKHAR GOLLA MD
Other - Org Name:MCKNIGHT MEDICAL CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:MD SOLE PROPRIETOR
Authorized Official - Prefix:
Authorized Official - First Name:CHANDRASEKHAR
Authorized Official - Middle Name:
Authorized Official - Last Name:GOLLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:412-364-0333
Mailing Address - Street 1:9401 MCKNIGHT RD
Mailing Address - Street 2:SUITE 302
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15237-6000
Mailing Address - Country:US
Mailing Address - Phone:412-364-0333
Mailing Address - Fax:
Practice Address - Street 1:9401 MCKNIGHT RD
Practice Address - Street 2:SUITE 302
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15237-6000
Practice Address - Country:US
Practice Address - Phone:412-364-0333
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-01
Last Update Date:2011-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD0386611L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0006812260003Medicaid
PA441726OtherBLUE SHIELD
153747Medicare PIN
B40051Medicare UPIN