Provider Demographics
NPI:1881931194
Name:ADVANCED OPHTHALMOLOGY PITTSBURGH LLC
Entity type:Organization
Organization Name:ADVANCED OPHTHALMOLOGY PITTSBURGH LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RAMAKUMAR
Authorized Official - Middle Name:N
Authorized Official - Last Name:GOUNDER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:412-489-6455
Mailing Address - Street 1:2520 MOSSIDE BLVD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:MONROEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15146-3539
Mailing Address - Country:US
Mailing Address - Phone:412-374-1220
Mailing Address - Fax:412-374-8220
Practice Address - Street 1:2520 MOSSIDE BLVD
Practice Address - Street 2:SUITE 1
Practice Address - City:MONROEVILLE
Practice Address - State:PA
Practice Address - Zip Code:15146-3539
Practice Address - Country:US
Practice Address - Phone:412-374-1220
Practice Address - Fax:412-374-8220
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ADVANCED OPHTHALMOLOGY PITTSBURGH LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-01-07
Last Update Date:2013-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD417220207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAH46255Medicare UPIN