Healthcare Provider Details

I. General information

NPI: 1831787399
Provider Name (Legal Business Name): BARTOLOMUCCI FAMILY MEDICINE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2021
Last Update Date: 05/21/2021
Certification Date: 05/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 VILLAGE DR
GREENSBURG PA
15601-3787
US

IV. Provider business mailing address

120 VILLAGE DR
GREENSBURG PA
15601-3787
US

V. Phone/Fax

Practice location:
  • Phone: 244-205-9287
  • Fax: 724-219-3120
Mailing address:
  • Phone: 412-554-8451
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: KEVIN MICHAEL BARTOLOMUCCI
Title or Position: PHYSICIAN
Credential: DO
Phone: 724-420-5928