Healthcare Provider Details

I. General information

NPI: 1740660711
Provider Name (Legal Business Name): ADVANCED RHEUMATOLOGY AND ARTHRITIS RESEARCH CENTER PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2015
Last Update Date: 05/29/2024
Certification Date: 05/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

144 EMERYVILLE DR STE 220
CRANBERRY TWP PA
16066-5015
US

IV. Provider business mailing address

144 EMERYVILLE DR STE 220
CRANBERRY TWP PA
16066-5015
US

V. Phone/Fax

Practice location:
  • Phone: 724-935-9355
  • Fax: 724-935-9360
Mailing address:
  • Phone: 724-935-9355
  • Fax: 724-935-9360

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number021096E
License Number StatePA

VII. Legacy identifiers

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

# 1
Identifier00723139
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer

VIII. Authorized Official

Name: ANGELA M STUPI
Title or Position: PRACTICE OWNER
Credential: M.D.
Phone: 724-935-9355