Healthcare Provider Details

I. General information

NPI: 1760743843
Provider Name (Legal Business Name): ANDREW PROUT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2012
Last Update Date: 03/23/2022
Certification Date: 03/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3550 TERRACE ST
PITTSBURGH PA
15213-2500
US

IV. Provider business mailing address

3550 TERRACE ST
PITTSBURGH PA
15213-2500
US

V. Phone/Fax

Practice location:
  • Phone: 412-647-3136
  • Fax: 412-647-8060
Mailing address:
  • Phone: 412-647-3136
  • Fax: 412-647-8060

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4301100912
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License Number4301501340
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: