Basic Information
| Provider Information | |||||||||
| NPI: | 1922165711 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PAINLEY | ||||||||
| FirstName: | PHILLIP | ||||||||
| MiddleName: | G | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.O. | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 2550 MOSSIDE BLVD | ||||||||
| Address2: | STE 208 | ||||||||
| City: | MONROEVILLE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 151463531 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4123736666 | ||||||||
| FaxNumber: | 4123734595 | ||||||||
| Practice Location | |||||||||
| Address1: | 2550 MOSSIDE BLVD | ||||||||
| Address2: | STE 208 | ||||||||
| City: | MONROEVILLE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 151463531 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4123736666 | ||||||||
| FaxNumber: | 4123734595 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/02/2007 | ||||||||
| LastUpdateDate: | 10/08/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| AuthorizedOfficialTitleorPosition: | |||||||||
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| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | 10/08/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | OS013920 | PA | N | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | 207RI0011X | OS013920 | PA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Interventional Cardiology |
ID Information
| ID | Type | State | Issuer | Description | 102677477 | 05 | PA | MEDICAID |