Healthcare Provider Details

I. General information

NPI: 1356907497
Provider Name (Legal Business Name): MANUEL GIRALDO GRUESO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2019
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date: 01/13/2020
Reactivation Date: 01/28/2020

III. Provider practice location address

200 LOTHROP ST
PITTSBURGH PA
15213-2536
US

IV. Provider business mailing address

200 LOTHROP ST
PITTSBURGH PA
15213-2536
US

V. Phone/Fax

Practice location:
  • Phone: 412-648-6200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMD492969
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: