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General NPI Number Information
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NPI Number | 1528509791
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Entity Type | Organization
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Legal Business Name | PITTSBURGH ALLEGHENY RETINA CONSULTANTS, LLC
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Dates
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Enumeration Date | 03/20/2017
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Last Update Date | 05/03/2017
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Provider Practice Location Address
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Address Line | 420 E NORTH AVE SUITE 116
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City | PITTSBURGH
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State | PA
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Zip | 15212-4746
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Country | US
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Telephone | 412-359-6296
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Fax |
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Provider Business Mailing Address
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Address Line | 420 E NORTH AVE SUITE 116
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City | PITTSBURGH
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State | PA
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Zip | 15212-4746
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Country | US
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Telephone | 412-576-6560
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Fax | 412-359-3370
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Authorized Official
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Title or Position | PRESIDENT/SOLE MEMBER
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Name | THIERRY C VERSTRAETEN
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Credential | M.D.
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Telephone | 412-576-6560
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number |
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License Number State |
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