1114141777 NPI number — MRS. KRISTIN MARIE NOVIC PA-C

Table of content: KELLEY ANN BELTRAN FNP (NPI 1063949600)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114141777 NPI number — MRS. KRISTIN MARIE NOVIC PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NOVIC
Provider First Name:
KRISTIN
Provider Middle Name:
MARIE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
PA-C
Provider Gender Code:
F

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:
1114141777
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
402 PAPPAN DRIVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
IMPERIAL
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15126
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
724-513-5678
Provider Business Mailing Address Fax Number:
724-695-9259

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
ALLEGHENY GENERAL HOSPITAL
Provider Second Line Business Practice Location Address:
320 EAST NORTH AVENUE, 6TH FLOOR, SOUTH TOWER
Provider Business Practice Location Address City Name:
PITTSBURGH
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15212
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
412-359-5036
Provider Business Practice Location Address Fax Number:
412-359-3305
Provider Enumeration Date:
04/12/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363A00000X , with the licence number:  MA051134 , 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)