MEDICARE: CONEMAUGH HEALTH INITIATIVES

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	2084N0400X	Neurology Physician	MD418166	PA

General Provider Information

NPI Number	:	1407859580
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CONEMAUGH HEALTH INITIATIVES

Provider Business Mailing Address
First Line	:	1086 FRANKLIN ST
Second Line	:
City	:	JOHNSTOWN
State	:	PA
Zip	:	15905-4305
Country	:	US
Telephone Number	:	814-535-8885
Fax Number	:	814-535-8720

Provider Business Practice Location Address
First Line	:	1450 SCALP AVE
Second Line	:
City	:	JOHNSTOWN
State	:	PA
Zip	:	15904-3374
Country	:	US
Telephone Number	:	814-534-5700
Fax Number	:	814-269-5233

Authorized Official
Title or Position	:	CHIEF OPERATING OFFICER
Name	:	ELAINE M LAMBERT
Credential	:
Telephone Number	:	814-533-1630

Provider Enumeration Date	:	05/23/2005
Last Update Date	:	08/22/2020

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