Healthcare Provider Details

I. General information

NPI: 1851103600
Provider Name (Legal Business Name): RYAN ANSELMINO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/20/2025
Last Update Date: 10/07/2025
Certification Date: 10/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12351 PERRY HWY
WEXFORD PA
15090-8344
US

IV. Provider business mailing address

4 ALLEGHENY CTR FL 7
PITTSBURGH PA
15212-5227
US

V. Phone/Fax

Practice location:
  • Phone: 412-359-6656
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberMA066351
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOA007162
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: