Healthcare Provider Details

I. General information

NPI: 1366885642
Provider Name (Legal Business Name): UPMC COMMUNITY MEDICINE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2013
Last Update Date: 04/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

419 WESTINGHOUSE AVE
WILMERDING PA
15148-1171
US

IV. Provider business mailing address

419 WESTINGHOUSE AVE
WILMERDING PA
15148-1171
US

V. Phone/Fax

Practice location:
  • Phone: 412-816-1818
  • Fax: 412-816-1811
Mailing address:
  • Phone: 412-816-1818
  • Fax: 412-816-1811

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. MARK T EHALT
Title or Position: SR.DIRECTOR
Credential:
Phone: 412-647-0943