Healthcare Provider Details

I. General information

NPI: 1205879541
Provider Name (Legal Business Name): MCMURRAY PEDIATRIC AND ADOLESCENT MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2006
Last Update Date: 10/02/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6000 WATERDAM PLAZA DR SUITE 280
MC MURRAY PA
15317-5413
US

IV. Provider business mailing address

6000 WATERDAM PLAZA DR SUITE 280
MC MURRAY PA
15317-5413
US

V. Phone/Fax

Practice location:
  • Phone: 724-941-8199
  • Fax: 724-942-6423
Mailing address:
  • Phone: 724-941-8199
  • Fax: 724-942-6423

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License NumberMD419996
License Number StatePA

VII. Legacy identifiers

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

VIII. Authorized Official

Name: TONJA J DICAMILLO
Title or Position: OWNER
Credential: MD
Phone: 724-941-8199