Healthcare Provider Details

I. General information

NPI: 1104206358
Provider Name (Legal Business Name): TYLER JOHN VANDYCK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/03/2015
Last Update Date: 07/29/2025
Certification Date: 07/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

490 E NORTH AVE STE 305
PITTSBURGH PA
15212-4740
US

IV. Provider business mailing address

490 E NORTH AVE STE 300
PITTSBURGH PA
15212-4771
US

V. Phone/Fax

Practice location:
  • Phone: 412-322-7202
  • Fax: 412-322-2144
Mailing address:
  • Phone: 412-322-7202
  • Fax: 412-322-2144

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberMD469933
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: