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General NPI Number Information
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NPI Number | 1578715157
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Entity Type | Organization
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Legal Business Name | HERITAGE VALLEY MEDICAL GROUP, INC.
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Dates
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Enumeration Date | 10/15/2008
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Last Update Date | 06/29/2012
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Provider Practice Location Address
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Address Line | 525 LOCUST PL
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City | SEWICKLEY
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State | PA
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Zip | 15143-1503
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Country | US
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Telephone | 412-741-4044
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Fax | 412-741-6820
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Provider Business Mailing Address
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Address Line | 525 LOCUST PL
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City | SEWICKLEY
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State | PA
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Zip | 15143-1503
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Country | US
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Telephone | 412-741-4044
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Fax | 412-741-6820
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Authorized Official
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Title or Position | PRESIDENT & CEO
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Name | NORMAN F. MITRY
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Credential |
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Telephone | 724-773-4776
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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 |
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License Number State |
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