1760571475 NPI number — PEDIATRIC & ADULT ALLERGY & ASTHMA

Table of content: (NPI 1760571475)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760571475 NPI number — PEDIATRIC & ADULT ALLERGY & ASTHMA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PEDIATRIC & ADULT ALLERGY & ASTHMA
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:
Provider Other Organization Name Type Code:
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:
1760571475
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/21/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5750 CENTRE AVE
Provider Second Line Business Mailing Address:
270
Provider Business Mailing Address City Name:
PITTSBURGH
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15206-3721
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
412-361-8355
Provider Business Mailing Address Fax Number:
412-361-8616

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5750 CENTRE AVE
Provider Second Line Business Practice Location Address:
270
Provider Business Practice Location Address City Name:
PITTSBURGH
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15206-3721
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
412-361-8355
Provider Business Practice Location Address Fax Number:
412-361-8616
Provider Enumeration Date:
10/12/2006

Additional Information

Authorized Official

Authorized Official Last Name:
WEBER
Authorized Official First Name:
LAWRENCE
Authorized Official Middle Name:
WN
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
412-361-8355

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  MD190953 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0015301370003 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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