Healthcare Provider Details

I. General information

NPI: 1801018445
Provider Name (Legal Business Name): ALLEGHENY CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 11/09/2020
Certification Date: 10/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1307 FEDERAL STREET 2ND FLOOR
PITTSBURGH PA
15212-4756
US

IV. Provider business mailing address

1307 FEDERAL STREET 2ND FLOOR
PITTSBURGH PA
15212-4756
US

V. Phone/Fax

Practice location:
  • Phone: 877-660-6777
  • Fax: 412-359-8055
Mailing address:
  • Phone: 877-660-6777
  • Fax: 412-359-8055

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License NumberMD-050617-L
License Number StatePA

VIII. Authorized Official

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