Healthcare Provider Details

I. General information

NPI: 1922533298
Provider Name (Legal Business Name): ERIC MICHAEL WATT BOCPO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2017
Last Update Date: 04/25/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 CEDAR RIDGE DR SUITE 205
PITTSBURGH PA
15205-9691
US

IV. Provider business mailing address

300 ALPHA DR
PITTSBURGH PA
15238-2908
US

V. Phone/Fax

Practice location:
  • Phone: 412-921-3004
  • Fax:
Mailing address:
  • Phone: 412-599-1138
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code222Z00000X
TaxonomyOrthotist
License NumberOH000290
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code224P00000X
TaxonomyProsthetist
License NumberPO000200
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: