MEDICARE: ELLEN M REDINBAUGH PHD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	PS008860L	PA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	168753	OTHER	PA	MEDICARE PTAN

General Provider Information

NPI Number	:	1548233109
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELLEN M REDINBAUGH PHD

Provider Business Mailing Address
First Line	:	401 SHADY AVE
Second Line	:	SUITE 201C
City	:	PITTSBURGH
State	:	PA
Zip	:	15206-4409
Country	:	US
Telephone Number	:	412-425-5918
Fax Number	:	412-422-9649

Provider Business Practice Location Address
First Line	:	401 SHADY AVE
Second Line	:	SUITE 201C
City	:	PITTSBURGH
State	:	PA
Zip	:	15206-4409
Country	:	US
Telephone Number	:	412-425-5918
Fax Number	:	412-422-9649

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/13/2006
Last Update Date	:	06/01/2012

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