Healthcare Provider Details

I. General information

NPI: 1336396159
Provider Name (Legal Business Name): ADVANCED OPHTHALMOLOGY EAST
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2008
Last Update Date: 02/03/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2520 MOSSIDE BLVD SUITE 1
MONROEVILLE PA
15146-3539
US

IV. Provider business mailing address

2520 MOSSIDE BLVD SUITE 1
MONROEVILLE PA
15146-3539
US

V. Phone/Fax

Practice location:
  • Phone: 412-374-1220
  • Fax: 412-374-8220
Mailing address:
  • Phone: 412-374-1220
  • Fax: 412-374-8220

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMD417220
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code305S00000X
TaxonomyPoint of Service
License NumberMD417220
License Number StatePA

VIII. Authorized Official

Name: DR. RAMAKUMAR NATARAJAN GOUNDER
Title or Position: OPHTHALMOLOGIST
Credential: M.D.
Phone: 412-374-1220