Provider Demographics
NPI:1255861001
Name:GUDURA, TARIKU TADELE (MD)
Entity type:Individual
Prefix:DR
First Name:TARIKU
Middle Name:TADELE
Last Name:GUDURA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:575 COAL VALLEY RD STE 204
Mailing Address - Street 2:
Mailing Address - City:CLAIRTON
Mailing Address - State:PA
Mailing Address - Zip Code:15025-3724
Mailing Address - Country:US
Mailing Address - Phone:412-466-2220
Mailing Address - Fax:412-466-4048
Practice Address - Street 1:17 ARENTZEN BLVD STE 204
Practice Address - Street 2:
Practice Address - City:CHARLEROI
Practice Address - State:PA
Practice Address - Zip Code:15022-1085
Practice Address - Country:US
Practice Address - Phone:724-489-0220
Practice Address - Fax:724-489-0855
Is Sole Proprietor?:No
Enumeration Date:2017-06-14
Last Update Date:2024-08-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL125.070266207R00000X
IN01084186A207R00000X
IL036152123208M00000X
PAMD484066207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1043201090001Medicaid