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General NPI Number Information
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NPI Number | 1154387942
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Entity Type | Organization
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Legal Business Name | FORT PITT SURGICAL ASSOCIATES, LLC
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Dates
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Enumeration Date | 04/21/2006
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Last Update Date | 09/23/2022
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Provider Practice Location Address
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Address Line | 8199 MCKNIGHT RD STE 102
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City | PITTSBURGH
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State | PA
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Zip | 15237-5749
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Country | US
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Telephone | 412-364-5490
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Fax | 412-364-5493
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Provider Business Mailing Address
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Address Line | 8199 MCKNIGHT RD STE 102
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City | PITTSBURGH
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State | PA
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Zip | 15237-5749
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Country | US
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Telephone | 412-364-5490
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Fax | 412-364-5493
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Authorized Official
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Title or Position | GENERAL SURGEON
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Name | TIMOTHY DOUGLAS JACOB
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Credential | MD
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Telephone | 412-364-5490
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | MD042446L
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License Number State | PA
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