Healthcare Provider Details

I. General information

NPI: 1053365643
Provider Name (Legal Business Name): ALLERGY & CLINICAL IMMUNOLOGY ASSOCIATES, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

180 FORT COUCH RD SUITE 375
PITTSBURGH PA
15241-1041
US

IV. Provider business mailing address

180 FORT COUCH RD SUITE 375
PITTSBURGH PA
15241-1041
US

V. Phone/Fax

Practice location:
  • Phone: 412-833-8811
  • Fax: 412-833-7011
Mailing address:
  • Phone: 412-833-8811
  • Fax: 412-833-7011

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License NumberMD009759E
License Number StatePA

VIII. Authorized Official

Name: MS. LISA M WHITE
Title or Position: PRACTICE ADMINISTRATOR
Credential:
Phone: 412-833-6768