Healthcare Provider Details

I. General information

NPI: 1275822157
Provider Name (Legal Business Name): ANDREW JOSEPH GENTILIN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2011
Last Update Date: 03/21/2024
Certification Date: 03/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1145 BOWER HILL RD STE 105
PITTSBURGH PA
15243-1346
US

IV. Provider business mailing address

458 IRONWOOD DR
CANONSBURG PA
15317-9569
US

V. Phone/Fax

Practice location:
  • Phone: 304-925-4086
  • Fax:
Mailing address:
  • Phone: 304-610-5047
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number26860
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: