Healthcare Provider Details

I. General information

NPI: 1982024428
Provider Name (Legal Business Name): ANGELICA CERCONE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2014
Last Update Date: 05/24/2021
Certification Date: 06/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4401 PENN AVE AOB 2ND FLOOR SUITE 2400
PITTSBURGH PA
15224-1334
US

IV. Provider business mailing address

3600 FORBES AVE STE 140
PITTSBURGH PA
15213-3410
US

V. Phone/Fax

Practice location:
  • Phone: 412-692-7980
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35131683
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: