Basic Information
Provider Information
NPI: 1215415088
EntityType: 2
ReplacementNPI:  
OrganizationName: ALLEGHENY CLINIC
LastName:  
FirstName:  
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName: CYPHER OB/GYN
OtherOrganizationType: 3
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 4 ALLEGHENY CTR FL 7
Address2:  
City: PITTSBURGH
State: PA
PostalCode: 152125255
CountryCode: US
TelephoneNumber: 4123305861
FaxNumber: 4123305844
Practice Location
Address1: 5375 WILLIAM FLYNN HWY
Address2:  
City: GIBSONIA
State: PA
PostalCode: 150449666
CountryCode: US
TelephoneNumber: 7244493245
FaxNumber: 7244493233
Other Information
ProviderEnumerationDate: 08/02/2018
LastUpdateDate: 11/06/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: NOEL
AuthorizedOfficialFirstName: DENISE
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition: DIRECTOR PROVIDER ENROLLMENT
AuthorizedOfficialTelephone: 4123305861
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 11/06/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207V00000X  Y193200000X MULTI-SPECIALTY GROUPAllopathic & Osteopathic PhysiciansObstetrics & Gynecology 

No ID Information.


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