Healthcare Provider Details

I. General information

NPI: 1528357043
Provider Name (Legal Business Name): JARED EVAN KNICKELBEIN MD/PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2011
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 OXFORD DR STE 300
MONROEVILLE PA
15146-2357
US

IV. Provider business mailing address

300 OXFORD DR STE 300
MONROEVILLE PA
15146-2357
US

V. Phone/Fax

Practice location:
  • Phone: 412-683-5300
  • Fax: 412-349-8655
Mailing address:
  • Phone: 412-683-5300
  • Fax: 412-349-8655

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License Number31576
License Number StateWV
# 2
Primary TaxonomyY
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License NumberMD451955
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: