Healthcare Provider Details

I. General information

NPI: 1063848042
Provider Name (Legal Business Name): ALLEGHENY CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2013
Last Update Date: 11/06/2020
Certification Date: 11/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1130 PERRY HWY
PITTSBURGH PA
15237-2142
US

IV. Provider business mailing address

1130 PERRY HWY
PITTSBURGH PA
15237-2142
US

V. Phone/Fax

Practice location:
  • Phone: 412-847-2615
  • Fax: 412-847-2623
Mailing address:
  • Phone: 412-847-2615
  • Fax: 412-847-2623

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: LYNN CHILTON
Title or Position: PROVIDER CREDENTIALING SPECIALIST
Credential:
Phone: 412-330-5852