Basic Information
| Provider Information | |||||||||
| NPI: | 1992751218 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GOBAO | ||||||||
| FirstName: | RICHARD | ||||||||
| MiddleName: | ALLEN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1000 BOWER HILL ROAD | ||||||||
| Address2: | ST CLAIR HOSPITAL - AFFILIATE BILLING - PAMALYN | ||||||||
| City: | PITTSBURGH | ||||||||
| State: | PA | ||||||||
| PostalCode: | 152431873 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4129422548 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2000 OXFORD DR STE 420 | ||||||||
| Address2: | |||||||||
| City: | BETHEL PARK | ||||||||
| State: | PA | ||||||||
| PostalCode: | 151021841 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4129422980 | ||||||||
| FaxNumber: | 4129422989 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/26/2006 | ||||||||
| LastUpdateDate: | 03/08/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/08/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | MD036621E | PA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 0012925540003 | 05 | PA | MEDICAID |