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General NPI Number Information
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NPI Number | 1366487720
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Entity Type | Organization
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Legal Business Name | MITRE GASTROENTEROLOGY ASSOCIATES
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Dates
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Enumeration Date | 06/19/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 925 BRIGHTON RD
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City | PITTSBURGH
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State | PA
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Zip | 15233-1707
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Country | US
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Telephone | 412-321-1648
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Fax | 412-321-4216
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Provider Business Mailing Address
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Address Line | 925 BRIGHTON RD
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City | PITTSBURGH
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State | PA
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Zip | 15233-1707
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Country | US
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Telephone | 412-321-1648
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Fax | 412-321-4216
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | RICARDO MITRE
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Credential | M.D.
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Telephone | 412-321-1648
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | MD032806L
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License Number State | NJ
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