Healthcare Provider Details

I. General information

NPI: 1548672843
Provider Name (Legal Business Name): WEXFORD ALLERGY ASTHMA & IMMUNOLOGY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2014
Last Update Date: 10/03/2022
Certification Date: 10/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 BRADFORD RD STE 410
WEXFORD PA
15090-8486
US

IV. Provider business mailing address

100 BRADFORD RD STE 410
WEXFORD PA
15090-8486
US

V. Phone/Fax

Practice location:
  • Phone: 724-719-2441
  • Fax: 724-719-2451
Mailing address:
  • Phone: 724-719-2441
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License NumberMD428339
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2080P0201X
TaxonomyPediatric Allergy/Immunology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ELLEN T SCHOLNICOFF
Title or Position: PHYSICIAN
Credential: MD
Phone: 724-719-2441