=====================================================
General NPI Number Information
=====================================================
NPI Number | 1609855212
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CHARLES A DEFRANCESCO MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/12/2006
-----------------------------------------------------
Last Update Date | 04/27/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 100 BRUSH RUN RD
-----------------------------------------------------
City | GREENSBURG
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15601-8753
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 724-691-0354
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1699 WASHINGTON RD STE 307
-----------------------------------------------------
City | PITTSBURGH
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15228-1629
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 412-831-3744
-----------------------------------------------------
Fax | 412-831-5663
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207L00000X
-----------------------------------------------------
Taxonomy Name | Anesthesiology Physician
-----------------------------------------------------
License Number | MD029492E
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------