MEDICARE: WESTERN PENNSYLVANIA PSYCH CARE

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	2084P0800X	Psychiatry Physician	MD040433E	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1670882	OTHER	PA	TRADITIONAL BC/BS

General Provider Information

NPI Number	:	1134380728
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WESTERN PENNSYLVANIA PSYCH CARE

Provider Business Mailing Address
First Line	:	1607 3RD ST
Second Line	:
City	:	BEAVER
State	:	PA
Zip	:	15009-2420
Country	:	US
Telephone Number	:	724-728-8411
Fax Number	:	724-728-8410

Provider Business Practice Location Address
First Line	:	200 OLD POND RD STE 107
Second Line	:
City	:	BRIDGEVILLE
State	:	PA
Zip	:	15017-1269
Country	:	US
Telephone Number	:	412-220-0341
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. RAJENDRA K NIGAM
Credential	:	MD
Telephone Number	:	724-728-8411

Provider Enumeration Date	:	06/17/2008
Last Update Date	:	06/17/2008

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Directions to “WESTERN PENNSYLVANIA PSYCH CARE ” Practice Location

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