Healthcare Provider Details

I. General information

NPI: 1154963387
Provider Name (Legal Business Name): ANDREW TKACIK PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/09/2019
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4800 FRIENDSHIP AVE FL 1
PITTSBURGH PA
15224-1722
US

IV. Provider business mailing address

320 E NORTH AVE
PITTSBURGH PA
15212-4756
US

V. Phone/Fax

Practice location:
  • Phone: 412-578-1890
  • Fax: 412-578-6925
Mailing address:
  • Phone: 412-359-2459
  • Fax: 412-359-8233

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberMA065622
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number026835
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: