Healthcare Provider Details

I. General information

NPI: 1063428852
Provider Name (Legal Business Name): BENJAMIN L KISSLINGER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

VA PITTSBURGH HEALTHCARE SYSTEM, PRIMARY CARE, 130P-H 7180 HIGHLAND DRIVE
PITTSBURGH PA
15206-1297
US

IV. Provider business mailing address

VA PITTSBURGH HEALTHCARE SYSTEM, PRIMARY CARE, 130P-H 7180 HIGHLAND DRIVE
PITTSBURGH PA
15206-1297
US

V. Phone/Fax

Practice location:
  • Phone: 412-365-5201
  • Fax: 412-365-5225
Mailing address:
  • Phone: 412-365-5201
  • Fax: 412-365-5225

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD073368L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: