MEDICARE: JENNIFER F HOULIAHN P.A.

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	MA052133	PA

General Provider Information

NPI Number	:	1780669010
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER F HOULIAHN P.A.

Provider Business Mailing Address
First Line	:	300 HALKET ST
Second Line	:	RENAISSANCE ORTHOPAEDICS, SUITE 1601
City	:	PITTSBURGH
State	:	PA
Zip	:	15213-3108
Country	:	US
Telephone Number	:	412-683-7272
Fax Number	:	412-683-0341

Provider Business Practice Location Address
First Line	:	300 HALKET ST
Second Line	:	RENAISSANCE ORTHOPAEDICS, SUITE 1601
City	:	PITTSBURGH
State	:	PA
Zip	:	15213-3108
Country	:	US
Telephone Number	:	412-683-7272
Fax Number	:	412-683-0341

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

Provider Enumeration Date	:	12/09/2005
Last Update Date	:	07/08/2007

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