Healthcare Provider Details

I. General information

NPI: 1114535028
Provider Name (Legal Business Name): ALLEGHENY CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2020
Last Update Date: 11/06/2020
Certification Date: 11/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2508 MYRTLE ST STE 100
ERIE PA
16502-2700
US

IV. Provider business mailing address

4 ALLEGHENY CTR FL 7
PITTSBURGH PA
15212-5255
US

V. Phone/Fax

Practice location:
  • Phone: 814-452-7134
  • Fax: 814-454-2003
Mailing address:
  • Phone: 412-330-5861
  • Fax: 412-330-5844

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License Number
License Number State

VIII. Authorized Official

Name: CINDY WALTEMIRE
Title or Position: PROVIDER ENROLLMENT SPECIALIST
Credential:
Phone: 412-330-5864