Healthcare Provider Details

I. General information

NPI: 1538725700
Provider Name (Legal Business Name): GOLLA ENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2019
Last Update Date: 05/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 GAMMA DR STE 110
PITTSBURGH PA
15238-2917
US

IV. Provider business mailing address

107 GAMMA DR STE 110
PITTSBURGH PA
15238-2917
US

V. Phone/Fax

Practice location:
  • Phone: 412-897-6411
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. SUMAN GOLLA
Title or Position: OWNER
Credential: MD
Phone: 412-897-6411