Healthcare Provider Details

I. General information

NPI: 1821098138
Provider Name (Legal Business Name): ALLEGHENY CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2005
Last Update Date: 07/21/2022
Certification Date: 11/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1307 FEDERAL ST STE B100
PITTSBURGH PA
15212-4761
US

IV. Provider business mailing address

4 ALLEGHENY CTR FL 7
PITTSBURGH PA
15212-5255
US

V. Phone/Fax

Practice location:
  • Phone: 412-359-8900
  • Fax: 412-359-8977
Mailing address:
  • Phone: 412-330-5861
  • Fax: 412-330-5844

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State

VIII. Authorized Official

Name: CANDICE GENTILE
Title or Position: PROVIDER ENROLLMENT SPECIALIST
Credential:
Phone: 412-330-5853