Basic Information
| Provider Information | |||||||||
| NPI: | 1174875348 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PHYSICIAN LANDING ZONE, P.C. | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | MARK H. WHOLEY, M.D. | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 120 5TH AVE | ||||||||
| Address2: | SUITE 2516 | ||||||||
| City: | PITTSBURGH | ||||||||
| State: | PA | ||||||||
| PostalCode: | 152223000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4125440818 | ||||||||
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| Practice Location | |||||||||
| Address1: | 490 E NORTH AVE | ||||||||
| Address2: | SUITE 307 | ||||||||
| City: | PITTSBURGH | ||||||||
| State: | PA | ||||||||
| PostalCode: | 152124740 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4123595822 | ||||||||
| FaxNumber: | 4123596620 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/11/2012 | ||||||||
| LastUpdateDate: | 07/17/2013 | ||||||||
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| AuthorizedOfficialLastName: | GOLDFARB | ||||||||
| AuthorizedOfficialFirstName: | WILLIAM | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 4125787080 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0204X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Vascular & Interventional Radiology |
ID Information
| ID | Type | State | Issuer | Description | 0007169850014 | 05 | PA | MEDICAID |