MEDICARE: GOWDA-TRIVEDI LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	DS036359	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1083868822
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GOWDA-TRIVEDI LLC

Provider Business Mailing Address
First Line	:	7265 REVERE ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19149-1429
Country	:	US
Telephone Number	:	215-335-0707
Fax Number	:	215-335-0797

Provider Business Practice Location Address
First Line	:	7265 REVERE ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19149-1429
Country	:	US
Telephone Number	:	215-335-0707
Fax Number	:	215-335-0797

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	PRIYA BAROT
Credential	:
Telephone Number	:	215-335-0707

Provider Enumeration Date	:	11/06/2008
Last Update Date	:	11/06/2008

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Directions to “GOWDA-TRIVEDI LLC ” Practice Location

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