Healthcare Provider Details

I. General information

NPI: 1851822019
Provider Name (Legal Business Name): MARK FACCHIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2017
Last Update Date: 08/23/2023
Certification Date: 08/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4401 PENN AVENUE UPMC CHILDREN'S HOSPITAL OF PITTSBURGH DEPARTMENT OF ANESTHESIA-SUITE 5643
PITTSBURGH PA
15224
US

IV. Provider business mailing address

3600 FORBES AVENUE FORBES TOWER-PLAZA LEVEL SUITE 140
PITTSBURGH PA
15213
US

V. Phone/Fax

Practice location:
  • Phone: 412-692-4528
  • Fax:
Mailing address:
  • Phone: 619-638-6950
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP3000X
TaxonomyPediatric Anesthesiology Physician
License Number70660
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateMA
# 3
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number272300
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: