Provider Demographics
NPI:1972678233
Name:BRUCE J NOTHMANN MD & SUDHIR K NARLA MD PC
Entity Type:Organization
Organization Name:BRUCE J NOTHMANN MD & SUDHIR K NARLA MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SUDHIR
Authorized Official - Middle Name:K
Authorized Official - Last Name:NARLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:412-672-5766
Mailing Address - Street 1:1320 FIFTH AVENUE
Mailing Address - Street 2:SUITE A
Mailing Address - City:MCKEESPORT
Mailing Address - State:PA
Mailing Address - Zip Code:15132
Mailing Address - Country:US
Mailing Address - Phone:412-672-5766
Mailing Address - Fax:412-672-8113
Practice Address - Street 1:1320 FIFTH AVENUE
Practice Address - Street 2:SUITE A
Practice Address - City:MCKEESPORT
Practice Address - State:PA
Practice Address - Zip Code:15132
Practice Address - Country:US
Practice Address - Phone:412-672-5766
Practice Address - Fax:412-672-8113
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-22
Last Update Date:2010-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD015084E207RG0100X
PAMD038033L207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0880990Medicaid
PA0008849260001Medicaid
PA064199IMedicaid
PA196434OtherHIGHMARK BLUE CROSS SHIEL
B36515Medicare UPIN
B37309Medicare UPIN
PA0008849260001Medicaid