Healthcare Provider Details

I. General information

NPI: 1336576834
Provider Name (Legal Business Name): GOLLA CENTER FOR PLASTIC SURGERY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2013
Last Update Date: 10/31/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 GAMMA DR SUITE 210
PITTSBURGH PA
15238-2917
US

IV. Provider business mailing address

1027 BANK ST
BRIDGEVILLE PA
15017-2201
US

V. Phone/Fax

Practice location:
  • Phone: 412-596-7081
  • Fax:
Mailing address:
  • Phone: 412-977-1966
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberSP013109
License Number StatePA

VIII. Authorized Official

Name: DR. DINAKAR GOLLA
Title or Position: PHYSICIAN
Credential: M.D.
Phone: 412-596-7081