Healthcare Provider Details

I. General information

NPI: 1114983780
Provider Name (Legal Business Name): CAROLYN KUBIK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2006
Last Update Date: 03/25/2021
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

419 RODI RD
PITTSBURGH PA
15235-4520
US

IV. Provider business mailing address

419 RODI ROAD
PITTSBURGH PA
15235-4566
US

V. Phone/Fax

Practice location:
  • Phone: 412-731-8000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License Number022799E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: