Healthcare Provider Details

I. General information

NPI: 1538435854
Provider Name (Legal Business Name): BRIAN CZERVIONKE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2012
Last Update Date: 08/28/2023
Certification Date: 08/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 CENTURY BLVD STE 5
CRANBERRY TOWNSHIP PA
16066-1420
US

IV. Provider business mailing address

100 CENTURY BLVD STE 5
CRANBERRY TOWNSHIP PA
16066-1420
US

V. Phone/Fax

Practice location:
  • Phone: 724-776-4433
  • Fax: 724-776-4475
Mailing address:
  • Phone: 724-776-4433
  • Fax: 724-776-4475

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD454545
License Number StatePA

VII. Legacy identifiers

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: