1023060779 NPI number — PLASTIC SURGICAL ASSOCIATES OF PITTSBURGH, P.C.

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 1023060779 NPI number — PLASTIC SURGICAL ASSOCIATES OF PITTSBURGH, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PLASTIC SURGICAL ASSOCIATES OF PITTSBURGH, P.C.
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:
BRAGDON-STOFMAN PLASTIC SURGERY GROUP PC
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:
1023060779
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/18/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 719
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MONROEVILLE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15146-0719
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
412-457-0175
Provider Business Mailing Address Fax Number:
412-457-0179

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1050 BOWER HILL RD
Provider Second Line Business Practice Location Address:
SUITE 105
Provider Business Practice Location Address City Name:
PITTSBURGH
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15243-1800
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
412-572-6164
Provider Business Practice Location Address Fax Number:
412-572-6156
Provider Enumeration Date:
05/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BRAGDON
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
W
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
412-572-6164

Provider Taxonomy Codes

  • Taxonomy code: 208200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1015516860001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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