Basic Information
| Provider Information | |||||||||
| NPI: | 1548647175 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CULBERTSON | ||||||||
| FirstName: | JESSICA | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 575 COAL VALLEY RD STE 300 | ||||||||
| Address2: | |||||||||
| City: | CLAIRTON | ||||||||
| State: | PA | ||||||||
| PostalCode: | 150253770 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4122676600 | ||||||||
| FaxNumber: | 4122676281 | ||||||||
| Practice Location | |||||||||
| Address1: | 575 COAL VALLEY RD STE 300 | ||||||||
| Address2: | |||||||||
| City: | CLAIRTON | ||||||||
| State: | PA | ||||||||
| PostalCode: | 150253770 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4122676600 | ||||||||
| FaxNumber: | 4122676281 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/04/2015 | ||||||||
| LastUpdateDate: | 08/09/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/09/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | OS019852 | PA | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 10325211 | 05 | PA | MEDICAID |