Basic Information
| Provider Information | |||||||||
| NPI: | 1770534786 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MCG GERIATRIC MEDICINE ASSOCIATES, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1518 FORBES AVE | ||||||||
| Address2: | |||||||||
| City: | PITTSBURGH | ||||||||
| State: | PA | ||||||||
| PostalCode: | 152195112 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4122325546 | ||||||||
| FaxNumber: | 4122325548 | ||||||||
| Practice Location | |||||||||
| Address1: | 1350 LOCUST ST | ||||||||
| Address2: | STE G102 BUILDING C | ||||||||
| City: | PITTSBURGH | ||||||||
| State: | PA | ||||||||
| PostalCode: | 152194738 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4122328494 | ||||||||
| FaxNumber: | 4122328727 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/14/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | PRENDERGAST | ||||||||
| AuthorizedOfficialFirstName: | JOHN | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | LEAD PHYSICIAN | ||||||||
| AuthorizedOfficialTelephone: | 4122328494 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | Y | 193200000X MULTI-SPECIALTY GROUP | Other Service Providers | Specialist |
No ID Information.