Healthcare Provider Details

I. General information

NPI: 1487959839
Provider Name (Legal Business Name): LYSOSOMAL STORAGE DISEASE CLINICAL CARE NETWORK LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2011
Last Update Date: 05/05/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 WILSON DR
PITTSBURGH PA
15202-1321
US

IV. Provider business mailing address

21 WILSON DR
PITTSBURGH PA
15202-1321
US

V. Phone/Fax

Practice location:
  • Phone: 412-734-4672
  • Fax: 412-734-5476
Mailing address:
  • Phone: 412-734-4672
  • Fax: 412-734-5476

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207SG0201X
TaxonomyClinical Genetics (M.D.) Physician
License Number
License Number State

VIII. Authorized Official

Name: JOHN BARRANGER
Title or Position: CEO
Credential: MD
Phone: 412-734-4672