Basic Information
| Provider Information | |||||||||
| NPI: | 1770538787 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PATHOLOGY AND NUCLEAR MEDICINE OF PITTSBURGH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7 PARKWAY CENTER | ||||||||
| Address2: | SUITE 375 | ||||||||
| City: | PITTSBURGH | ||||||||
| State: | PA | ||||||||
| PostalCode: | 15220 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4129375700 | ||||||||
| FaxNumber: | 7702371492 | ||||||||
| Practice Location | |||||||||
| Address1: | 25 HECKEL RD | ||||||||
| Address2: | |||||||||
| City: | MC KEES ROCKS | ||||||||
| State: | PA | ||||||||
| PostalCode: | 15136 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4127776249 | ||||||||
| FaxNumber: | 4127776177 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/24/2006 | ||||||||
| LastUpdateDate: | 11/27/2007 | ||||||||
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| AuthorizedOfficialLastName: | OESTERLING | ||||||||
| AuthorizedOfficialFirstName: | EVERETT | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 4127776249 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207ZP0101X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology | 207U00000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Nuclear Medicine | 207ZP0102X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology & Clinical Pathology |
ID Information
| ID | Type | State | Issuer | Description | 0009943650009 | 05 | PA | MEDICAID | 110589 | 01 | PA | BLUE SHIELD | OTHER |