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General NPI Number Information
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NPI Number | 1336566652
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Entity Type | Organization
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Legal Business Name | BOSTON MEDICAL GROUP PENNSYLVANIA, P.C.
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Dates
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Enumeration Date | 03/25/2014
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Last Update Date | 03/25/2014
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Provider Practice Location Address
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Address Line | 420 FORT DUQUESNE BLVD.,SUITE 899 1 GATEWAY CENTER
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City | PITTSBURGH
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State | PA
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Zip | 15222
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Country | US
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Telephone | 412-338-0212
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Fax | 412-338-9161
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Provider Business Mailing Address
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Address Line | 420 FORT DUQUESNE BLVD.,SUITE 899 1 GATEWAY CENTER
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City | PITTSBURGH
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State | PA
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Zip | 15222
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Country | US
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Telephone | 412-338-0212
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Fax | 412-338-9161
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | MS. MARIANNE C. LABARBERA
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Credential | M.D.
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Telephone | 718-981-4070
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number |
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License Number State |
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