Healthcare Provider Details

I. General information

NPI: 1811945793
Provider Name (Legal Business Name): UNIVERSITY OF PITTSBURGH PHYSICIANS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 09/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 W FIFTH ST EAST LIVERPOOL CITY HOSPITAL
EAST LIVERPOOL OH
43920-2405
US

IV. Provider business mailing address

200 LOTHROP ST
PITTSBURGH PA
15213-2546
US

V. Phone/Fax

Practice location:
  • Phone: 330-386-3195
  • Fax: 330-386-3197
Mailing address:
  • Phone: 412-647-0943
  • Fax: 412-647-4050

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier113748
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerHIGHMARK MEDICARE GROUP

VIII. Authorized Official

Name: MARK EHALT
Title or Position: DIRECTOR, REVENUE CYCLE
Credential:
Phone: 412-647-0943