Provider Demographics
NPI:1326130030
Name:KOIMATTUR, ARWIND G (MD)
Entity Type:Individual
Prefix:
First Name:ARWIND
Middle Name:G
Last Name:KOIMATTUR
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 1:2566 HAYMAKER RD
Mailing Address - Street 2:SUITE 311 POB 1
Mailing Address - City:MONROEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15146-3517
Mailing Address - Country:US
Mailing Address - Phone:412-457-1030
Mailing Address - Fax:412-605-6550
Practice Address - Street 1:2566 HAYMAKER RD
Practice Address - Street 2:SUITE 311 POB 1
Practice Address - City:MONROEVILLE
Practice Address - State:PA
Practice Address - Zip Code:15146-3517
Practice Address - Country:US
Practice Address - Phone:412-457-1030
Practice Address - Fax:412-605-6550
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2013-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD018359E208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0134072Medicaid
PA000752794Medicaid
WV3810011998Medicaid
PA0007527940005Medicaid
PAP00629741Medicare PIN
WV3810011998Medicaid
PA000752794Medicaid
PA004788PNLMedicare PIN