Healthcare Provider Details

I. General information

NPI: 1023060779
Provider Name (Legal Business Name): PLASTIC SURGICAL ASSOCIATES OF PITTSBURGH, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 02/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1050 BOWER HILL RD SUITE 105
PITTSBURGH PA
15243-1800
US

IV. Provider business mailing address

PO BOX 719
MONROEVILLE PA
15146-0719
US

V. Phone/Fax

Practice location:
  • Phone: 412-572-6164
  • Fax: 412-572-6156
Mailing address:
  • Phone: 412-457-0175
  • Fax: 412-457-0179

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ROBERT W BRAGDON
Title or Position: PRESIDENT
Credential: MD
Phone: 412-572-6164