Basic Information
| Provider Information | |||||||||
| NPI: | 1639643208 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | ALLEGHENY CLINIC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 501 BRADDOCK AVE | ||||||||
| Address2: | |||||||||
| City: | BRADDOCK | ||||||||
| State: | PA | ||||||||
| PostalCode: | 151041856 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4126365054 | ||||||||
| FaxNumber: | 4122712361 | ||||||||
| Practice Location | |||||||||
| Address1: | 501 BRADDOCK AVE | ||||||||
| Address2: | |||||||||
| City: | BRADDOCK | ||||||||
| State: | PA | ||||||||
| PostalCode: | 151041856 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4126365054 | ||||||||
| FaxNumber: | 4122712361 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/17/2019 | ||||||||
| LastUpdateDate: | 01/17/2019 | ||||||||
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| AuthorizedOfficialLastName: | NOEL | ||||||||
| AuthorizedOfficialFirstName: | DENISE | ||||||||
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| AuthorizedOfficialTitleorPosition: | DIRECTOR PROVIDER ENROLLMENT | ||||||||
| AuthorizedOfficialTelephone: | 4123305861 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.