Healthcare Provider Details

I. General information

NPI: 1285059618
Provider Name (Legal Business Name): WHITEHALL MEDICAL HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2014
Last Update Date: 02/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4500 CLAIRTON BLVD
PITTSBURGH PA
15236-2161
US

IV. Provider business mailing address

4500 CLAIRTON BLVD
PITTSBURGH PA
15236-2161
US

V. Phone/Fax

Practice location:
  • Phone: 412-885-2929
  • Fax: 412-279-3416
Mailing address:
  • Phone: 412-885-2929
  • Fax: 412-279-3416

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License NumberMD420553
License Number StatePA

VIII. Authorized Official

Name: DEBRA LEONARD
Title or Position: CREDENTIALING MANAGER
Credential:
Phone: 412-885-2929