Healthcare Provider Details

I. General information

NPI: 1598765778
Provider Name (Legal Business Name): PITTSBURGH VASCULAR SURGICAL ASSOCIATES PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2005
Last Update Date: 06/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5200 CENTRE AVE SUITE 705
PITTSBURGH PA
15232-1300
US

IV. Provider business mailing address

5200 CENTRE AVE SUITE 705
PITTSBURGH PA
15232-1300
US

V. Phone/Fax

Practice location:
  • Phone: 412-681-8720
  • Fax: 412-681-8713
Mailing address:
  • Phone: 412-681-8720
  • Fax: 412-681-8713

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMD024651E
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberMD024651E
License Number StatePA

VIII. Authorized Official

Name: DR. FREDRIC JARRETT
Title or Position: PRESIDENT
Credential: M.D.,
Phone: 412-681-8720