Healthcare Provider Details

I. General information

NPI: 1548203094
Provider Name (Legal Business Name): NICOLE RADICH DOBSON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NICOLE ANN RADICH MD

II. Dates (important events)

Enumeration Date: 06/13/2006
Last Update Date: 01/31/2023
Certification Date: 01/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 HALKET ST
PITTSBURGH PA
15213-3108
US

IV. Provider business mailing address

3240 CRAFT PL STE 200
PITTSBURGH PA
15213-4571
US

V. Phone/Fax

Practice location:
  • Phone: 412-641-1000
  • Fax:
Mailing address:
  • Phone: 412-641-4109
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License NumberMD475314
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: