Healthcare Provider Details

I. General information

NPI: 1194024976
Provider Name (Legal Business Name): ELIZABETH KENNEDY HEWETT BRUMBERG MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ELIZABETH KENNEDY HEWETT MD

II. Dates (important events)

Enumeration Date: 03/20/2011
Last Update Date: 07/31/2021
Certification Date: 07/31/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4401 PENN AVE
PITTSBURGH PA
15224-1334
US

IV. Provider business mailing address

4401 PENN AVE
PITTSBURGH PA
15224-1334
US

V. Phone/Fax

Practice location:
  • Phone: 412-692-7692
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0204X
TaxonomyPediatric Emergency Medicine (Pediatrics) Physician
License NumberMD460319
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: