MEDICARE: ALISA B. PENICH PA-C

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	363AM0700X	Medical Physician Assistant	MA053448	PA

General Provider Information

NPI Number	:	1588815898
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALISA B. PENICH PA-C

Provider Business Mailing Address
First Line	:	3433 WILLIAM PENN HWY
Second Line	:
City	:	PITTSBURGH
State	:	PA
Zip	:	15235-5412
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3433 WILLIAM PENN HWY
Second Line	:
City	:	PITTSBURGH
State	:	PA
Zip	:	15235-5412
Country	:	US
Telephone Number	:	412-825-3627
Fax Number	:

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

Provider Enumeration Date	:	10/06/2008
Last Update Date	:	10/06/2008

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Directions to “ ALISA B. PENICH PA-C” Practice Location

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