MEDICARE: DR. COLLEEN K EBBERT MD

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	207Q00000X	Family Medicine Physician	MD056817L	PA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	080112250	OTHER		RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	175950	OTHER	PA	HIGHMARK
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1780623306
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. COLLEEN K EBBERT MD

Provider Business Mailing Address
First Line	:	600 WATERCREST WAY
Second Line	:	SUITE 630
City	:	CHESWICK
State	:	PA
Zip	:	15024-1370
Country	:	US
Telephone Number	:	724-274-9451
Fax Number	:	724-274-9370

Provider Business Practice Location Address
First Line	:	200 DELAFIELD RD STE 2030
Second Line	:
City	:	PITTSBURGH
State	:	PA
Zip	:	15215-3214
Country	:	US
Telephone Number	:	412-782-2101
Fax Number	:	412-782-2108

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

Provider Enumeration Date	:	06/06/2006
Last Update Date	:	01/23/2008

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