Healthcare Provider Details

I. General information

NPI: 1316987662
Provider Name (Legal Business Name): KELLIE MICHELE EGIDI PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2006
Last Update Date: 03/09/2021
Certification Date: 03/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

717 WASHINGTON RD
PITTSBURGH PA
15228-2001
US

IV. Provider business mailing address

1000 BOWER HILL RD ATTN ST CLAIR HOSPITAL - AFFILIATE BILLING - PAMALYN
PITTSBURGH PA
15243-1873
US

V. Phone/Fax

Practice location:
  • Phone: 412-341-7887
  • Fax: 412-341-1479
Mailing address:
  • Phone: 412-942-2674
  • Fax: 412-942-2689

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMA002530L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: