=====================================================
General NPI Number Information
=====================================================
NPI Number | 1114927530
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ALLEGHENY CLINIC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/28/2005
-----------------------------------------------------
Last Update Date | 07/21/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 320 E NORTH AVE
-----------------------------------------------------
City | PITTSBURGH
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15212-4756
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 412-359-3400
-----------------------------------------------------
Fax | 412-359-3171
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 320 E NORTH AVE
-----------------------------------------------------
City | PITTSBURGH
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15212-4756
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 412-359-3400
-----------------------------------------------------
Fax | 412-359-3171
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR PROVIDER ENROLLMENT
-----------------------------------------------------
Name | DENISE NOEL
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 412-330-5861
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2085R0001X
-----------------------------------------------------
Taxonomy Name | Radiation Oncology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------