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	207Q00000X	Family Medicine Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	042490	OTHER	PA	MC GROUP PTAN

General Provider Information

NPI Number	:	1861942278
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UPMC COMMUNITY MEDICINE INC

Provider Business Mailing Address
First Line	:	12279 ROUTE 30
Second Line	:
City	:	NORTH HUNTINGDON
State	:	PA
Zip	:	15642-1876
Country	:	US
Telephone Number	:	724-864-7101
Fax Number	:	724-864-7160

Provider Business Practice Location Address
First Line	:	12279 ROUTE 30
Second Line	:
City	:	NORTH HUNTINGDON
State	:	PA
Zip	:	15642-1876
Country	:	US
Telephone Number	:	724-864-7101
Fax Number	:	724-864-7160

Authorized Official
Title or Position	:	SR. MANAGER
Name	:	MARY CALDWELL
Credential	:
Telephone Number	:	412-432-5846

Provider Enumeration Date	:	10/10/2016
Last Update Date	:	10/10/2016

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Directions to “UPMC COMMUNITY MEDICINE INC ” Practice Location

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