Healthcare Provider Details

I. General information

NPI: 1922448703
Provider Name (Legal Business Name): COLIN FITZGERALD SLEMENDA DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/26/2013
Last Update Date: 08/21/2024
Certification Date: 08/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

575 COAL VALLEY RD STE 570
JEFFERSON HILLS PA
15025-3729
US

IV. Provider business mailing address

575 COAL VALLEY RD STE 570
JEFFERSON HILLS PA
15025-3729
US

V. Phone/Fax

Practice location:
  • Phone: 412-697-6604
  • Fax: 412-469-7547
Mailing address:
  • Phone: 124-697-6604
  • Fax: 412-469-7547

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberOS020182
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License NumberOS020182
License Number StatePA

VII. Legacy identifiers

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

# 1
Identifier103241780
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer
# 2
Identifier1E0054
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerMEDICARE
# 3
Identifier6507387
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerAETNA PIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: