Provider Demographics
NPI:1912014549
Name:PUNUKOLLU, CHANDRASEKHARA. RAO (MD)
Entity Type:Individual
Prefix:DR
First Name:CHANDRASEKHARA.
Middle Name:RAO
Last Name:PUNUKOLLU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:C.
Other - Middle Name:RAO
Other - Last Name:PUNUKOLLU
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:520 JEFFERSON AVE
Mailing Address - Street 2:SUITE 400
Mailing Address - City:JEANNETTE
Mailing Address - State:PA
Mailing Address - Zip Code:15644-2538
Mailing Address - Country:US
Mailing Address - Phone:724-527-8060
Mailing Address - Fax:724-522-4002
Practice Address - Street 1:443 FRYE FARM RD
Practice Address - Street 2:SUITE 100
Practice Address - City:GREENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15601-2338
Practice Address - Country:US
Practice Address - Phone:724-532-5360
Practice Address - Fax:724-879-4033
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2016-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD041732L207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0012140750009Medicaid
PA0012140750004Medicaid
PA0012140750004Medicaid
E55926Medicare UPIN
619053RS5Medicare ID - Type Unspecified