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	207RG0300X	Geriatric Medicine (Internal Medicine) Physician

General Provider Information

NPI Number	:	1942337712
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UPMC COMMUNITY MEDICINE INC

Provider Business Mailing Address
First Line	:	4212 OLD WILLIAM PENN HWY
Second Line	:
City	:	MURRYSVILLE
State	:	PA
Zip	:	15668-1901
Country	:	US
Telephone Number	:	724-733-1725
Fax Number	:

Provider Business Practice Location Address
First Line	:	4212 OLD WILLIAM PENN HWY
Second Line	:
City	:	MURRYSVILLE
State	:	PA
Zip	:	15668-1901
Country	:	US
Telephone Number	:	724-733-1725
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	:	10/09/2007

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