Healthcare Provider Details

I. General information

NPI: 1669296307
Provider Name (Legal Business Name): INFECTIOUS DISEASE TELE-MEDICAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/11/2024
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5800 CORPORATE DR STE 300
PITTSBURGH PA
15237-7098
US

IV. Provider business mailing address

5800 CORPORATE DR STE 300
PITTSBURGH PA
15237-7098
US

V. Phone/Fax

Practice location:
  • Phone: 833-271-2408
  • Fax:
Mailing address:
  • Phone: 833-271-2408
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: LIYUEN G. WILLS
Title or Position: DIRECTOR, CREDENTIALING SERVICES
Credential:
Phone: 724-383-6195