Healthcare Provider Details

I. General information

NPI: 1174510689
Provider Name (Legal Business Name): ALLEGHENY CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2005
Last Update Date: 07/21/2022
Certification Date: 10/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 E NORTH AVE FL 3
PITTSBURGH PA
15212-4756
US

IV. Provider business mailing address

320 E NORTH AVE FL 3
PITTSBURGH PA
15212-4756
US

V. Phone/Fax

Practice location:
  • Phone: 412-359-6147
  • Fax: 412-359-8559
Mailing address:
  • Phone: 412-359-6147
  • Fax: 412-359-8559

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number
License Number StatePA

VIII. Authorized Official

Name: DENISE NOEL
Title or Position: DIRECTOR PROVIDER ENROLLMENT
Credential:
Phone: 412-330-5861