MEDICARE: MT LEBANON INTERNAL MEDICINE, PC

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	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1366468704
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MT LEBANON INTERNAL MEDICINE, PC

Provider Business Mailing Address
First Line	:	300 CEDAR BLVD
Second Line	:
City	:	PITTSBURGH
State	:	PA
Zip	:	15228-1155
Country	:	US
Telephone Number	:	412-561-1484
Fax Number	:	412-561-7145

Provider Business Practice Location Address
First Line	:	300 CEDAR BLVD
Second Line	:
City	:	PITTSBURGH
State	:	PA
Zip	:	15228-1155
Country	:	US
Telephone Number	:	412-561-1484
Fax Number	:	412-561-7145

Authorized Official
Title or Position	:	CHIEF OPERATING OFFICER
Name	:	KARL E BUSHMAN
Credential	:	MD
Telephone Number	:	412-561-1484

Provider Enumeration Date	:	07/15/2006
Last Update Date	:	02/26/2010

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