Basic Information
| Provider Information | |||||||||
| NPI: | 1164719860 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | UPMC COMMUNITY MEDICINE INC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | COMPREHENSIVE CARE ASSOCIATES-UPMC | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5200 CENTRE AVE | ||||||||
| Address2: | |||||||||
| City: | PITTSBURGH | ||||||||
| State: | PA | ||||||||
| PostalCode: | 152321300 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4126477788 | ||||||||
| FaxNumber: | 4126474050 | ||||||||
| Practice Location | |||||||||
| Address1: | 5200 CENTRE AVE | ||||||||
| Address2: | |||||||||
| City: | PITTSBURGH | ||||||||
| State: | PA | ||||||||
| PostalCode: | 152321300 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4126477788 | ||||||||
| FaxNumber: | 4126474050 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/01/2011 | ||||||||
| LastUpdateDate: | 02/08/2012 | ||||||||
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| AuthorizedOfficialLastName: | EHALT | ||||||||
| AuthorizedOfficialFirstName: | MARK | ||||||||
| AuthorizedOfficialMiddleName: | T | ||||||||
| AuthorizedOfficialTitleorPosition: | SR.DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 44126470943 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.