=====================================================
General NPI Number Information
=====================================================
NPI Number | 1013664630
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FORT PITT PHYSICIANS, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/03/2022
-----------------------------------------------------
Last Update Date | 03/03/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 455 E BRUCETON RD
-----------------------------------------------------
City | PITTSBURGH
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15236-4538
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 412-848-4403
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1017 AUGUSTA WAY
-----------------------------------------------------
City | PITTSBURGH
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15236-2072
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 412-848-4403
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | SEAN W LEEHAN
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 412-848-4403
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------