Provider Demographics
NPI:1720222714
Name:LAUREL HIGHLANDS SURGERY, P.C.
Entity Type:Organization
Organization Name:LAUREL HIGHLANDS SURGERY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KUMUDA
Authorized Official - Middle Name:R
Authorized Official - Last Name:PRADHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:814-443-1028
Mailing Address - Street 1:223 S PLEASANT AVE
Mailing Address - Street 2:SUITE 403
Mailing Address - City:SOMERSET
Mailing Address - State:PA
Mailing Address - Zip Code:15501-2183
Mailing Address - Country:US
Mailing Address - Phone:814-443-1028
Mailing Address - Fax:814-443-2910
Practice Address - Street 1:223 S PLEASANT AVE
Practice Address - Street 2:SUITE 403
Practice Address - City:SOMERSET
Practice Address - State:PA
Practice Address - Zip Code:15501-2183
Practice Address - Country:US
Practice Address - Phone:814-443-1028
Practice Address - Fax:814-443-2910
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-22
Last Update Date:2009-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAI33995Medicare UPIN