Basic Information
| Provider Information | |||||||||
| NPI: | 1326076134 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | VIDAL-PHELAN | ||||||||
| FirstName: | JOHANNA | ||||||||
| MiddleName: | MARIA | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3420 5TH AVE | ||||||||
| Address2: | |||||||||
| City: | PITTSBURGH | ||||||||
| State: | PA | ||||||||
| PostalCode: | 152133205 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4126926000 | ||||||||
| FaxNumber: | 4126923180 | ||||||||
| Practice Location | |||||||||
| Address1: | 3420 5TH AVE | ||||||||
| Address2: | |||||||||
| City: | PITTSBURGH | ||||||||
| State: | PA | ||||||||
| PostalCode: | 152133205 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4126926000 | ||||||||
| FaxNumber: | 4126923180 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/29/2006 | ||||||||
| LastUpdateDate: | 08/02/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/02/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 25MA08355600 | NJ | N | Allopathic & Osteopathic Physicians | Pediatrics | 208000000X | MD432442 | PA | Y | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.