Basic Information
| Provider Information | |||||||||
| NPI: | 1669437588 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WEST PENN MEDICAL ASSOCIATES, P.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4727 FRIENDSHIP AVE | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | PITTSBURGH | ||||||||
| State: | PA | ||||||||
| PostalCode: | 152241779 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4122355810 | ||||||||
| FaxNumber: | 4122355890 | ||||||||
| Practice Location | |||||||||
| Address1: | 4727 FRIENDSHIP AVE | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | PITTSBURGH | ||||||||
| State: | PA | ||||||||
| PostalCode: | 152241779 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4122355810 | ||||||||
| FaxNumber: | 4122355890 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/20/2006 | ||||||||
| LastUpdateDate: | 10/11/2010 | ||||||||
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| AuthorizedOfficialLastName: | GOLDBERG | ||||||||
| AuthorizedOfficialFirstName: | ELLIOT | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 4122355810 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | 207RC0200X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Critical Care Medicine | 207RR0500X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Rheumatology | 207RP1001X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease | 207R00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 0012647380022 | 05 | PA | MEDICAID |