Basic Information
Provider Information | |||||||||
NPI: | 1598865503 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | LOBL | ||||||||
FirstName: | ANDREW | ||||||||
MiddleName: | BARBROW | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | PO BOX 1236 | ||||||||
Address2: |   | ||||||||
City: | BUTLER | ||||||||
State: | PA | ||||||||
PostalCode: | 160031236 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4129378887 | ||||||||
FaxNumber: | 4129379221 | ||||||||
Practice Location | |||||||||
Address1: | 100 S JACKSON AVE | ||||||||
Address2: | 5TH FLOOR | ||||||||
City: | PITTSBURGH | ||||||||
State: | PA | ||||||||
PostalCode: | 152023428 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4124151138 | ||||||||
FaxNumber: | 4123010113 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 09/22/2006 | ||||||||
LastUpdateDate: | 11/11/2014 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | MD070485L | PA | Y |   | Allopathic & Osteopathic Physicians | Family Medicine |   |
ID Information
ID | Type | State | Issuer | Description | P00399382 | 01 | PA | RR MEDICARE | OTHER | 219932 | 01 | PA | UPMC | OTHER | 18506730007 | 05 | PA |   | MEDICAID | P004602 | 01 | PA | GATEWAY HEALTH PLAN | OTHER | 1301490 | 01 | PA | HIGHMARK BCBS | OTHER | 1943242 | 01 | PA | FIRST HEALTH | OTHER | 000000196654 | 01 | PA | UNISON | OTHER |