=====================================================
General NPI Number Information
=====================================================
NPI Number | 1073634036
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ANU GOWDA MD LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/03/2007
-----------------------------------------------------
Last Update Date | 06/18/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11618 FRANKSTOWN RD
-----------------------------------------------------
City | PITTSBURGH
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15235-3319
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 412-731-7170
-----------------------------------------------------
Fax | 412-731-7172
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11618 FRANKSTOWN RD
-----------------------------------------------------
City | PITTSBURGH
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15235-3319
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 412-731-7170
-----------------------------------------------------
Fax | 412-731-7172
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. ANURADHA GOWDA
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 412-731-7170
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | MD060383L
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------