Healthcare Provider Details

I. General information

NPI: 1487800348
Provider Name (Legal Business Name): RENAISSNANCE FAMILY PRACTICE-UPMC,INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2008
Last Update Date: 08/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5548 WILLIAM FLYNN HWY
GIBSONIA PA
15044-9315
US

IV. Provider business mailing address

5548 WILLIAM FLYNN HWY
GIBSONIA PA
15044-9315
US

V. Phone/Fax

Practice location:
  • Phone: 724-444-6330
  • Fax:
Mailing address:
  • Phone: 724-444-6330
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State

VIII. Authorized Official

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