Healthcare Provider Details

I. General information

NPI: 1942313119
Provider Name (Legal Business Name): EDWARD M. KENDJELIC PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7180 HIGHLAND DR
PITTSBURGH PA
15206-1206
US

IV. Provider business mailing address

7180 HIGHLAND DR
PITTSBURGH PA
15206-1206
US

V. Phone/Fax

Practice location:
  • Phone: 412-365-5195
  • Fax: 412-365-5330
Mailing address:
  • Phone: 412-365-5195
  • Fax: 412-365-5330

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License NumberPS-9050-L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: