Healthcare Provider Details

I. General information

NPI: 1649707431
Provider Name (Legal Business Name): HERITAGE VALLEY MEDICAL GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2017
Last Update Date: 05/11/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 HAZEL LN SUITE 300
SEWICKLEY PA
15143-1253
US

IV. Provider business mailing address

200 OHIO RIVER BLVD
BADEN PA
15005-1914
US

V. Phone/Fax

Practice location:
  • Phone: 412-749-7330
  • Fax: 412-749-7339
Mailing address:
  • Phone: 724-773-6802
  • Fax: 724-770-7919

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. NORMAN F MITRY
Title or Position: PRESIDENT & CEO
Credential:
Phone: 724-773-4776