MEDICARE: UPMC COMMUNITY MEDICINE INC

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	:	1770740961
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UPMC COMMUNITY MEDICINE INC

Provider Business Mailing Address
First Line	:	1432 LINCOLN WAY
Second Line	:	SUITE 201
City	:	MCKEESPORT
State	:	PA
Zip	:	15131-1600
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1432 LINCOLN WAY
Second Line	:	SUITE 201
City	:	MCKEESPORT
State	:	PA
Zip	:	15131-1600
Country	:	US
Telephone Number	:	412-647-3087
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MARK EHALT
Credential	:
Telephone Number	:	412-647-0943

Provider Enumeration Date	:	05/16/2008
Last Update Date	:	05/16/2008

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