Healthcare Provider Details

I. General information

NPI: 1588573778
Provider Name (Legal Business Name): UPMCTDI JV LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/03/2026
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20111 ROUTE 19 STE 300D
CRANBERRY TOWNSHIP PA
16066-6207
US

IV. Provider business mailing address

20111 ROUTE 19 STE 300D
CRANBERRY TOWNSHIP PA
16066-6207
US

V. Phone/Fax

Practice location:
  • Phone: 724-935-6200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number StateNULL

VIII. Authorized Official

Name: TIFFANY FOGLE
Title or Position: CREDENTIALING
Credential:
Phone: 919-763-1112