MEDICARE: ALLEGHENY CLINIC

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	207Q00000X	Family Medicine Physician		PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1639505613
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALLEGHENY CLINIC

Provider Business Mailing Address
First Line	:	125 EMERYVILLE DR
Second Line	:	SUITE 120
City	:	CRANBERRY TOWNSHIP
State	:	PA
Zip	:	16066-5020
Country	:	US
Telephone Number	:	412-772-2340
Fax Number	:	412-772-2347

Provider Business Practice Location Address
First Line	:	125 EMERYVILLE DR
Second Line	:	SUITE 120
City	:	CRANBERRY TOWNSHIP
State	:	PA
Zip	:	16066-5020
Country	:	US
Telephone Number	:	412-772-2340
Fax Number	:	412-772-2347

Authorized Official
Title or Position	:	ANALYST
Name	:	CECILI R JONES
Credential	:
Telephone Number	:	412-330-4813

Provider Enumeration Date	:	09/23/2013
Last Update Date	:	06/17/2014

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1457899627 — ANDREW KOHL
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Directions to “ALLEGHENY CLINIC ” Practice Location

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