Healthcare Provider Details

I. General information

NPI: 1669479283
Provider Name (Legal Business Name): ANGELO CONSTANTINO MD MPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/29/2005
Last Update Date: 12/23/2020
Certification Date: 12/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 FREEPORT RD STE 200
BLAWNOX PA
15238-3485
US

IV. Provider business mailing address

103 BUCKINGHAM RD OFFICE SUITE 1500
PITTSBURGH PA
15215-1505
US

V. Phone/Fax

Practice location:
  • Phone: 412-784-2323
  • Fax: 412-784-2320
Mailing address:
  • Phone: 412-578-0270
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD042865E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: