Healthcare Provider Details

I. General information

NPI: 1124016381
Provider Name (Legal Business Name): KEYSTONE DIGESTIVE DISORDER CONSULTANTS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4815 LIBERTY AVE SUITE M58
PITTSBURGH PA
15224-2156
US

IV. Provider business mailing address

4815 LIBERTY AVE SUITE M58
PITTSBURGH PA
15224-2156
US

V. Phone/Fax

Practice location:
  • Phone: 412-681-1616
  • Fax: 412-681-6438
Mailing address:
  • Phone: 412-681-1616
  • Fax: 412-681-6438

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ROBERT KANIA
Title or Position: PRESIDENT
Credential:
Phone: 412-681-1616