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General NPI Number Information
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NPI Number | 1356528152
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Entity Type | Organization
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Legal Business Name | PRIME MEDICAL GROUP
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Dates
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Enumeration Date | 01/24/2008
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Last Update Date | 01/24/2008
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Provider Practice Location Address
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Address Line | 1200 BROOKS LN SUITE 110
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City | CLAIRTON
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State | PA
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Zip | 15025-3747
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Country | US
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Telephone | 724-929-4930
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Fax | 724-929-4308
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Provider Business Mailing Address
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Address Line | PO BOX 18619
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City | PITTSBURGH
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State | PA
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Zip | 15236-0619
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Country | US
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Telephone | 724-929-4930
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Fax | 724-929-4308
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Authorized Official
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Title or Position | PRESIDENT OF PRACTIVE
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Name | DR. AMBARAM V CHAUHAN
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Credential | M.D.
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Telephone | 724-929-4930
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | MD037996L
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License Number State | PA
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