Healthcare Provider Details

I. General information

NPI: 1356338867
Provider Name (Legal Business Name): ALLEGHENY CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2005
Last Update Date: 10/14/2020
Certification Date: 10/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

490 E NORTH AVE STE 207
PITTSBURGH PA
15212-4740
US

IV. Provider business mailing address

490 E NORTH AVE STE 303
PITTSBURGH PA
15212-4740
US

V. Phone/Fax

Practice location:
  • Phone: 412-359-6640
  • Fax: 412-359-4148
Mailing address:
  • Phone: 412-359-6640
  • Fax: 412-359-4148

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License Number
License Number State

VIII. Authorized Official

Name: DENISE NOEL
Title or Position: DIRECTOR PROVIDER ENROLLMENT
Credential:
Phone: 412-330-5861