Healthcare Provider Details

I. General information

NPI: 1578576211
Provider Name (Legal Business Name): GENE DAVID DANDREA RD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

UNIVERSITY DRIVE MAIL STOP: 120NF-A
PITTSBURGH PA
15240
US

IV. Provider business mailing address

5008 MAMONT RD
MURRYSVILLE PA
15668-9322
US

V. Phone/Fax

Practice location:
  • Phone: 412-784-3584
  • Fax: 412-784-3722
Mailing address:
  • Phone: 724-733-4001
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code132700000X
TaxonomyDietary Manager
License NumberDN000632
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: