Healthcare Provider Details

I. General information

NPI: 1083701825
Provider Name (Legal Business Name): NORTH PARK OB/GYN ASSOCIATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 03/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9000 BROOKTREE RD SUITE 402
WEXFORD PA
15090-9255
US

IV. Provider business mailing address

9000 BROOKTREE RD SUITE 402
WEXFORD PA
15090-9255
US

V. Phone/Fax

Practice location:
  • Phone: 724-934-9344
  • Fax: 724-934-9343
Mailing address:
  • Phone: 724-934-9344
  • Fax: 724-934-9343

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License Number
License Number State

VIII. Authorized Official

Name: MISS MARY CATHERINE RUGGIERO
Title or Position: OFFICE MANAGER
Credential: RN
Phone: 724-934-9344