Healthcare Provider Details

I. General information

NPI: 1609946466
Provider Name (Legal Business Name): SOUTH HILLS NEPHROLOGY ASSOCIATES PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2006
Last Update Date: 07/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

575 COAL VALLEY RD STE 264
CLAIRTON PA
15025-3716
US

IV. Provider business mailing address

575 COAL VALLEY RD STE 264
CLAIRTON PA
15025-3716
US

V. Phone/Fax

Practice location:
  • Phone: 412-466-2220
  • Fax: 412-466-4048
Mailing address:
  • Phone: 412-466-2220
  • Fax: 412-466-4048

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD038478L
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberMD038478L
License Number StatePA

VIII. Authorized Official

Name: RAJNI WALLIA
Title or Position: MD
Credential:
Phone: 412-466-2220