MEDICARE: UPMC COMMUNITY MEDICINE INC

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	207R00000X	Internal Medicine Physician
2	207Q00000X	Family Medicine Physician

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	042568	OTHER	PA	HIGHMARK MEDICARE GROUP

General Provider Information

NPI Number	:	1639206402
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UPMC COMMUNITY MEDICINE INC

Provider Business Mailing Address
First Line	:	118 S ANDERSON ST
Second Line	:	SUITE 1
City	:	BEDFORD
State	:	PA
Zip	:	15522-1403
Country	:	US
Telephone Number	:	814-623-3474
Fax Number	:

Provider Business Practice Location Address
First Line	:	118 S ANDERSON ST
Second Line	:	SUITE 1
City	:	BEDFORD
State	:	PA
Zip	:	15522-1403
Country	:	US
Telephone Number	:	814-623-3474
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MARK EHALT
Credential	:
Telephone Number	:	412-647-0943

Provider Enumeration Date	:	02/27/2007
Last Update Date	:	09/05/2007

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Directions to “UPMC COMMUNITY MEDICINE INC ” Practice Location

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