Healthcare Provider Details

I. General information

NPI: 1821472812
Provider Name (Legal Business Name): ALLEGHENY CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2015
Last Update Date: 07/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

241 FREEPORT RD
ASPINWALL PA
15215-3035
US

IV. Provider business mailing address

241 FREEPORT RD
ASPINWALL PA
15215-3035
US

V. Phone/Fax

Practice location:
  • Phone: 412-784-8541
  • Fax: 412-784-8225
Mailing address:
  • Phone: 412-784-8541
  • Fax: 412-784-8225

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License Number
License Number StatePA

VII. Legacy identifiers

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

VIII. Authorized Official

Name: JANE WETZEL
Title or Position: PROVIDER CREDENTIALING SPECIALIST
Credential:
Phone: 412-330-5233