Healthcare Provider Details

I. General information

NPI: 1538331152
Provider Name (Legal Business Name): ALLEGHENY CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/25/2008
Last Update Date: 05/12/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

490 E NORTH AVE STE 500
PITTSBURGH PA
15212-4765
US

IV. Provider business mailing address

490 E NORTH AVE STE 500
PITTSBURGH PA
15212-4765
US

V. Phone/Fax

Practice location:
  • Phone: 412-359-8860
  • Fax: 412-359-8809
Mailing address:
  • Phone: 412-359-8860
  • Fax: 412-359-8809

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number
License Number State

VIII. Authorized Official

Name: CANDICE GENTILE
Title or Position: PROVIDER CREDENTIALING SPECIALIST
Credential:
Phone: 412-330-5853