MEDICARE: MS LEGACY, 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	251S00000X	Community/Behavioral Health Agency	MD425723	PA

General Provider Information

NPI Number	:	1972857936
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MS LEGACY, PC

Provider Business Mailing Address
First Line	:	5857 LONGVIEW CIR
Second Line	:
City	:	BRIDGEVILLE
State	:	PA
Zip	:	15017-1277
Country	:	US
Telephone Number	:	412-221-7770
Fax Number	:	412-221-7773

Provider Business Practice Location Address
First Line	:	80 EMERSON LN STE 1303
Second Line	:
City	:	BRIDGEVILLE
State	:	PA
Zip	:	15017-3472
Country	:	US
Telephone Number	:	412-221-7770
Fax Number	:	412-221-7773

Authorized Official
Title or Position	:	OWNER
Name	:	DR. MUHAMMAD ILYAS M.S. SHAIKH
Credential	:	M.D.
Telephone Number	:	412-221-7770

Provider Enumeration Date	:	10/30/2012
Last Update Date	:	10/03/2017

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