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NPI Code Detail

MEDICARE: CHILDREN'S COMMUNITY CARE

MEDICARE: CHILDREN'S COMMUNITY 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
1208000000XPediatrics Physician

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1000101763OTHERHIGHMARK ID#

General Provider Information

NPI Number : 1467469080
Entity Type Code : Organization
Provider Name (Legal Business Name) : CHILDREN'S COMMUNITY CARE
Provider Business Mailing Address
First Line : 103 BRADFORD RD STE 200
Second Line :
City : WEXFORD
State : PA
Zip : 15090-6910
Country : US
Telephone Number : 724-933-1100
Fax Number :
Provider Business Practice Location Address
First Line : 604 EPSILON DR
Second Line :
City : PITTSBURGH
State : PA
Zip : 15238-2808
Country : US
Telephone Number : 412-967-9090
Fax Number : 412-967-0186
Authorized Official
Title or Position : EXECUTIVE ADMINISTRATOR III
Name : LORI MARTINEZ
Credential :
Telephone Number : 724-933-1100
Provider Enumeration Date : 08/03/2006
Last Update Date : 09/13/2023

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1649273822 — JAMES N TUCKER MD
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Directions to “CHILDREN'S COMMUNITY CARE ” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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