Provider Demographics
NPI:1407297450
Name:PULI, AMOGHAVARSHA (MD)
Entity Type:Individual
Prefix:DR
First Name:AMOGHAVARSHA
Middle Name:
Last Name:PULI
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 1:3708 5TH AVE STE 501
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15213-3427
Mailing Address - Country:US
Mailing Address - Phone:412-586-3550
Mailing Address - Fax:
Practice Address - Street 1:3708 5TH AVE STE 501
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15213-3427
Practice Address - Country:US
Practice Address - Phone:125-864-3550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-07
Last Update Date:2020-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD463442207RN0300X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103526234Medicaid