Healthcare Provider Details

I. General information

NPI: 1457388894
Provider Name (Legal Business Name): PEDIATRIC ALLIANCE, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/28/2006
Last Update Date: 05/11/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 WASHINGTON AVE SUITE 215
CARNEGIE PA
15106-3614
US

IV. Provider business mailing address

1100 WASHINGTON AVE SUITE 215
CARNEGIE PA
15106-3614
US

V. Phone/Fax

Practice location:
  • Phone: 412-278-5100
  • Fax: 412-278-5105
Mailing address:
  • Phone: 412-278-5100
  • Fax: 412-278-5105

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VII. Legacy identifiers

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

VIII. Authorized Official

Name: MR. R JAMES TROUP
Title or Position: CEO
Credential:
Phone: 412-278-5100