Healthcare Provider Details

I. General information

NPI: 1790037059
Provider Name (Legal Business Name): EDWARD J. RUANE JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2012
Last Update Date: 01/08/2025
Certification Date: 01/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 OXFORD DR STE 410
BETHEL PARK PA
15102-1841
US

IV. Provider business mailing address

1000 BOWER HILL ROAD ST CLAIR HOSPITAL - AFFILIATE BILLING - PAMALYN
PITTSBURGH PA
15243-1873
US

V. Phone/Fax

Practice location:
  • Phone: 412-572-6164
  • Fax: 412-572-6156
Mailing address:
  • Phone: 412-924-2548
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberMD464046
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: