Healthcare Provider Details

I. General information

NPI: 1871682146
Provider Name (Legal Business Name): FORT PITT SENIOR HEALTH CARE ASSOCIATES, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 09/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1350 LOCUST ST SUITE G102
PITTSBURGH PA
15219-4738
US

IV. Provider business mailing address

1350 LOCUST ST SUITE G102
PITTSBURGH PA
15219-4738
US

V. Phone/Fax

Practice location:
  • Phone: 412-232-8494
  • Fax: 412-232-8727
Mailing address:
  • Phone: 412-232-8494
  • Fax: 412-232-8727

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMD038722E
License Number StatePA

VIII. Authorized Official

Name: DR. JOHN MICHAEL PRENDERGAST
Title or Position: PHYSICIAN
Credential: M.D., M.P.H.
Phone: 412-232-8494