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General NPI Number Information
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NPI Number | 1356561948
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Entity Type | Organization
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Legal Business Name | BROOKLINE MEDICAL ASSOC PC
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Dates
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Enumeration Date | 04/26/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 519 BROOKLINE BOULEVARD
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City | PITTSBURGH
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State | PA
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Zip | 15226
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Country | US
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Telephone | 412-341-2793
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Fax | 412-341-1622
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Provider Business Mailing Address
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Address Line | 519 BROOKLINE BOULEVARD
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City | PITTSBURGH
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State | PA
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Zip | 15226
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Country | US
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Telephone | 412-341-2793
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Fax | 412-341-1622
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Authorized Official
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Title or Position | PRESIDENT
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Name | THADDEUS ANDREW GREY
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Credential | MD
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Telephone | 412-341-2743
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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 | 039737 L
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License Number State | PA
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