=====================================================
General NPI Number Information
=====================================================
NPI Number | 1679200869
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ANDREA TOMKO
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/06/2022
-----------------------------------------------------
Last Update Date | 08/06/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4000 WASHINGTON RD
-----------------------------------------------------
City | CANONSBURG
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15317-2583
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 724-260-5918
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 151 DRAKE RD
-----------------------------------------------------
City | BETHEL PARK
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15102-1103
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 412-480-5609
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------