Healthcare Provider Details

I. General information

NPI: 1720515281
Provider Name (Legal Business Name): ANDREW GEORGESON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2017
Last Update Date: 07/21/2020
Certification Date: 07/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4070 BEECHWOOD BLVD
PITTSBURGH PA
15217-2679
US

IV. Provider business mailing address

810 CLAIRTON BLVD STE 100
PITTSBURGH PA
15236-5505
US

V. Phone/Fax

Practice location:
  • Phone: 412-521-6511
  • Fax: 412-521-6512
Mailing address:
  • Phone: 412-466-5004
  • Fax: 412-466-7137

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD470814
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: