Healthcare Provider Details

I. General information

NPI: 1467221226
Provider Name (Legal Business Name): ALLEGHENY CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/21/2023
Last Update Date: 12/21/2023
Certification Date: 12/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2419 STATE AVE STE 200
CORAOPOLIS PA
15108-2233
US

IV. Provider business mailing address

2419 STATE AVE STE 200
CORAOPOLIS PA
15108-2233
US

V. Phone/Fax

Practice location:
  • Phone: 412-625-2625
  • Fax: 412-625-2627
Mailing address:
  • Phone: 412-625-2625
  • Fax: 412-625-2627

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine 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: CINDY WALTEMIRE
Title or Position: PROVIDER ENROLLMENT SPECIALIST
Credential:
Phone: 412-330-5864