Healthcare Provider Details

I. General information

NPI: 1972297513
Provider Name (Legal Business Name): JOSHUA ROBERT KUCMEROSKI PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/06/2023
Last Update Date: 08/13/2023
Certification Date: 08/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1515 LOCUST ST STE 220
PITTSBURGH PA
15219-5131
US

IV. Provider business mailing address

1254 HILLSDALE AVE APT 2
PITTSBURGH PA
15216-2518
US

V. Phone/Fax

Practice location:
  • Phone: 412-232-5800
  • Fax:
Mailing address:
  • Phone: 724-961-3354
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XX0801X
TaxonomyOrthopaedic Trauma Physician
License NumberMA064548
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: