Healthcare Provider Details

I. General information

NPI: 1639419302
Provider Name (Legal Business Name): UNIVERSITY OF PITTSBURGH PHYSICIANS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/18/2013
Last Update Date: 02/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10455 LINCOLN HWY
EVERETT PA
15537-7046
US

IV. Provider business mailing address

10455 LINCOLN HWY
EVERETT PA
15537-7046
US

V. Phone/Fax

Practice location:
  • Phone: 814-623-6161
  • Fax:
Mailing address:
  • Phone: 814-623-6161
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZP0101X
TaxonomyAnatomic Pathology Physician
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code207ZC0006X
TaxonomyClinical Pathology Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: MARK T EHALT
Title or Position: SR.DIRECTOR
Credential:
Phone: 412-647-0943