Healthcare Provider Details

I. General information

NPI: 1346240363
Provider Name (Legal Business Name): FRED PAUL HARCHELROAD JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2005
Last Update Date: 08/05/2022
Certification Date: 08/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 E NORTH AVE AGH EMERGENCY ASSOCS
PITTSBURGH PA
15212
US

IV. Provider business mailing address

320 E NORTH AVE AGH EMERGENCY ASSOCS
PITTSBURGH PA
15212
US

V. Phone/Fax

Practice location:
  • Phone: 412-359-4138
  • Fax: 412-359-8874
Mailing address:
  • Phone: 412-359-4138
  • Fax: 412-359-8874

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207PT0002X
TaxonomyMedical Toxicology (Emergency Medicine) Physician
License NumberMD029308E
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberMD029308E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: