Healthcare Provider Details

I. General information

NPI: 1609840057
Provider Name (Legal Business Name): THOMAS CARL KRIVAK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/14/2006
Last Update Date: 08/11/2021
Certification Date: 08/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4815 LIBERTY AVE SUITE GR30
PITTSBURGH PA
15224-2156
US

IV. Provider business mailing address

4815 LIBERTY AVE SUITE GR30
PITTSBURGH PA
15224-2156
US

V. Phone/Fax

Practice location:
  • Phone: 412-578-1116
  • Fax: 412-578-1116
Mailing address:
  • Phone: 412-578-1116
  • Fax: 412-578-1116

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License NumberMD426420
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: