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General NPI Number Information
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NPI Number | 1912014549
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Entity Type | Individual
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Provider Name | CHANDRASEKHARA. RAO PUNUKOLLU MD
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Gender | Male
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Dates
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Enumeration Date | 08/23/2006
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Last Update Date | 02/07/2025
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Provider Practice Location Address
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Address Line | 508 S CHURCH ST STE 100
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City | MOUNT PLEASANT
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State | PA
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Zip | 15666-1702
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Country | US
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Telephone | 724-547-7212
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Fax | 724-547-7278
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Provider Business Mailing Address
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Address Line | 508 S CHURCH ST STE 100
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City | MT PLEASANT
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State | PA
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Zip | 15666-1702
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Country | US
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Telephone | 724-547-7212
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Fax | 724-547-7278
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | MD041732L
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License Number State | PA
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