Healthcare Provider Details

I. General information

NPI: 1972678233
Provider Name (Legal Business Name): BRUCE J NOTHMANN MD & SUDHIR K NARLA MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/22/2006
Last Update Date: 07/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1320 FIFTH AVENUE SUITE A
MCKEESPORT PA
15132
US

IV. Provider business mailing address

1320 FIFTH AVENUE SUITE A
MCKEESPORT PA
15132
US

V. Phone/Fax

Practice location:
  • Phone: 412-672-5766
  • Fax: 412-672-8113
Mailing address:
  • Phone: 412-672-5766
  • Fax: 412-672-8113

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberMD038033L
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberMD015084E
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier0880990
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer
# 2
Identifier0008849260001
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer
# 3
Identifier064199I
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer
# 4
Identifier196434
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerHIGHMARK BLUE CROSS SHIEL

VIII. Authorized Official

Name: DR. SUDHIR K NARLA
Title or Position: PRESIDENT
Credential: MD
Phone: 412-672-5766