MEDICARE: PLUM PEDIATRICS 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	208000000X	Pediatrics Physician	MD051024L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0014969000	OTHER	PA	INDEPENDENCE BLUE SHIELD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	128877	OTHER		HEALTH AMERICA
4	917554	OTHER	PA	HIGHMARK BLUE SHIELD
5	5267460	OTHER		AETNA PPO
6	62106	OTHER		UNISON HEALTH PLAN
7	1027145	OTHER		GATEWAY HEALTH PLAN
8	556984	OTHER		AETNA HMO

General Provider Information

NPI Number	:	1518943521
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PLUM PEDIATRICS PC

Provider Business Mailing Address
First Line	:	781 PINE VALLEY DR
Second Line	:
City	:	PITTSBURGH
State	:	PA
Zip	:	15239-2842
Country	:	US
Telephone Number	:	724-327-7586
Fax Number	:	724-327-9562

Provider Business Practice Location Address
First Line	:	781 PINE VALLEY DR
Second Line	:
City	:	PITTSBURGH
State	:	PA
Zip	:	15239-2842
Country	:	US
Telephone Number	:	724-327-7586
Fax Number	:	724-327-9562

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JAMIE CALABRESE
Credential	:	MD
Telephone Number	:	724-327-7586

Provider Enumeration Date	:	12/21/2005
Last Update Date	:	10/22/2007

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Directions to “PLUM PEDIATRICS PC ” Practice Location

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