Provider Demographics
NPI:1982751764
Name:PUNUKOLLU MD AND ASSOCIATES, P.C.
Entity type:Organization
Organization Name:PUNUKOLLU MD AND ASSOCIATES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:C
Authorized Official - Middle Name:RAO
Authorized Official - Last Name:PUNUKOLLU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:724-547-7212
Mailing Address - Street 1:480 EAGLE ST
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:PA
Mailing Address - Zip Code:15666-1700
Mailing Address - Country:US
Mailing Address - Phone:724-547-7212
Mailing Address - Fax:724-547-7278
Practice Address - Street 1:480 EAGLE ST
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:PA
Practice Address - Zip Code:15666-1700
Practice Address - Country:US
Practice Address - Phone:724-547-7212
Practice Address - Fax:724-547-7278
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA058184Medicare ID - Type Unspecified