Healthcare Provider Details

I. General information

NPI: 1326078551
Provider Name (Legal Business Name): BRENTWOOD MEDICAL ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/04/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3028 BROWNSVILLE RD
PITTSBURGH PA
15227-2402
US

IV. Provider business mailing address

3028 BROWNSVILLE RD
PITTSBURGH PA
15227-2402
US

V. Phone/Fax

Practice location:
  • Phone: 412-882-9455
  • Fax:
Mailing address:
  • Phone: 412-882-9455
  • Fax:

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: VINCENT LUCCHETTI
Title or Position: PRACTICE MANAGER
Credential:
Phone: 412-882-8455