Healthcare Provider Details

I. General information

NPI: 1336193036
Provider Name (Legal Business Name): AMY GATES NEVIN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 02/11/2021
Certification Date: 02/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3174 BEECHWOOD DR
ALLISON PARK PA
15101-1160
US

IV. Provider business mailing address

3174 BEECHWOOD DR
ALLISON PARK PA
15101-1160
US

V. Phone/Fax

Practice location:
  • Phone: 412-608-5259
  • Fax:
Mailing address:
  • Phone: 412-608-5259
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD074436L
License Number StatePA

VII. Legacy identifiers

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

# 1
Identifier0018934920003
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer
# 2
Identifier0018934920004
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: