=====================================================
General NPI Number Information
=====================================================
NPI Number | 1790037059
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | EDWARD J. RUANE JR. M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/11/2012
-----------------------------------------------------
Last Update Date | 01/08/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2000 OXFORD DR STE 410
-----------------------------------------------------
City | BETHEL PARK
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15102-1841
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 412-572-6164
-----------------------------------------------------
Fax | 412-572-6156
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1000 BOWER HILL ROAD ST CLAIR HOSPITAL - AFFILIATE BILLING - PAMALYN
-----------------------------------------------------
City | PITTSBURGH
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15243-1873
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 412-924-2548
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208200000X
-----------------------------------------------------
Taxonomy Name | Plastic Surgery Physician
-----------------------------------------------------
License Number | MD464046
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------