1063417350 NPI number — MCC CARDIOLOGY ASSOCIATES, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063417350 NPI number — MCC CARDIOLOGY ASSOCIATES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MCC CARDIOLOGY ASSOCIATES, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
MCS CARDIOLOGY SPECIALISTS
Provider Other Organization Name Type Code:
4
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1063417350
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1518 FORBES AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PITTSBURGH
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15219-5112
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
412-232-5546
Provider Business Mailing Address Fax Number:
412-232-5548

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1350 LOCUST ST
Provider Second Line Business Practice Location Address:
STE 300
Provider Business Practice Location Address City Name:
PITTSBURGH
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15219-4738
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
412-232-8011
Provider Business Practice Location Address Fax Number:
412-232-5639
Provider Enumeration Date:
06/14/2005

Additional Information

Authorized Official

Authorized Official Last Name:
GENERALOVICH
Authorized Official First Name:
THOMAS
Authorized Official Middle Name:
Authorized Official Title or Position:
LEAD PHYSICIAN
Authorized Official Telephone Number:
412-232-8011

Provider Taxonomy Codes

  • Taxonomy code: 173000000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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