Healthcare Provider Details

I. General information

NPI: 1639452543
Provider Name (Legal Business Name): NATHAN E KEGEL PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2011
Last Update Date: 09/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 LOTHROP ST FORBES TOWER, ROOM 9055
PITTSBURGH PA
15213-2536
US

IV. Provider business mailing address

3200 S WATER ST
PITTSBURGH PA
15203-2307
US

V. Phone/Fax

Practice location:
  • Phone: 412-647-3087
  • Fax:
Mailing address:
  • Phone: 412-432-3600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPS017082
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: