Basic Information
| Provider Information | |||||||||
| NPI: | 1871682146 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | FORT PITT SENIOR HEALTH CARE ASSOCIATES, P.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1350 LOCUST ST | ||||||||
| Address2: | SUITE G102 | ||||||||
| City: | PITTSBURGH | ||||||||
| State: | PA | ||||||||
| PostalCode: | 152194738 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4122328494 | ||||||||
| FaxNumber: | 4122328727 | ||||||||
| Practice Location | |||||||||
| Address1: | 1350 LOCUST ST | ||||||||
| Address2: | SUITE G102 | ||||||||
| City: | PITTSBURGH | ||||||||
| State: | PA | ||||||||
| PostalCode: | 152194738 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4122328494 | ||||||||
| FaxNumber: | 4122328727 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/12/2006 | ||||||||
| LastUpdateDate: | 09/13/2011 | ||||||||
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| AuthorizedOfficialLastName: | PRENDERGAST | ||||||||
| AuthorizedOfficialFirstName: | JOHN | ||||||||
| AuthorizedOfficialMiddleName: | MICHAEL | ||||||||
| AuthorizedOfficialTitleorPosition: | PHYSICIAN | ||||||||
| AuthorizedOfficialTelephone: | 4122328494 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D., M.P.H. | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 173000000X | N | 193200000X MULTI-SPECIALTY GROUP | Other Service Providers | Legal Medicine | 174400000X | MD038722E | PA | Y | 193200000X MULTI-SPECIALTY GROUP | Other Service Providers | Specialist |
No ID Information.