MEDICARE: PITTSBURGH VASCULAR SURGICAL ASSOCIATES PC

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	208600000X	Surgery Physician	MD024651E	PA
2	2086S0129X	Vascular Surgery Physician	MD024651E	PA

General Provider Information

NPI Number	:	1598765778
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PITTSBURGH VASCULAR SURGICAL ASSOCIATES PC

Provider Business Mailing Address
First Line	:	5200 CENTRE AVE
Second Line	:	SUITE 705
City	:	PITTSBURGH
State	:	PA
Zip	:	15232-1300
Country	:	US
Telephone Number	:	412-681-8720
Fax Number	:	412-681-8713

Provider Business Practice Location Address
First Line	:	5200 CENTRE AVE
Second Line	:	SUITE 705
City	:	PITTSBURGH
State	:	PA
Zip	:	15232-1300
Country	:	US
Telephone Number	:	412-681-8720
Fax Number	:	412-681-8713

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. FREDRIC JARRETT
Credential	:	M.D.,
Telephone Number	:	412-681-8720

Provider Enumeration Date	:	07/28/2005
Last Update Date	:	06/05/2008

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