Healthcare Provider Details

I. General information

NPI: 1558310326
Provider Name (Legal Business Name): ALLEGHENY CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2006
Last Update Date: 11/06/2020
Certification Date: 11/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 E NORTH AVE
PITTSBURGH PA
15212-4756
US

IV. Provider business mailing address

4 ALLEGHENY CTR FL 7
PITTSBURGH PA
15212-5255
US

V. Phone/Fax

Practice location:
  • Phone: 412-359-3155
  • Fax: 412-359-3483
Mailing address:
  • Phone: 412-330-5846
  • Fax: 412-330-5844

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number StatePA

VIII. Authorized Official

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