1144221102 NPI number — DR. SCOTT LAWRENCE PORTNOY MD

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144221102 NPI number — DR. SCOTT LAWRENCE PORTNOY MD

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

PORTNOY

Provider First Name:

SCOTT

Provider Middle Name:

LAWRENCE

Provider Name Prefix Text:

DR.

Provider Name Suffix Text:

Provider Credential Text:

MD

Provider Gender Code:

M

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:

1144221102

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

07/21/2010

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

2026 E CARSON ST

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:

15203-1902

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

412-381-1542

Provider Business Mailing Address Fax Number:

412-381-6662

Provider First Line Business Practice Location Address:

2853 FREEPORT ROAD

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

NATRONA HEIGHTS

Provider Business Practice Location Address State Name:

PA

Provider Business Practice Location Address Postal Code:

15065

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

724-224-4240

Provider Business Practice Location Address Fax Number:

724-224-3197

Provider Enumeration Date:

08/02/2005

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 207W00000X , with the licence number:  MD043503E , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 100723 . This is a "UPMC HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
• Identifier: 4550PA . This is a "VISION BENEFITS OF AMERIC" identifier . This identifiers is of the category "OTHER".
• Identifier: 81633 . This is a "HEALTH AMERICA/HEALTH ASS" identifier . This identifiers is of the category "OTHER".
• Identifier: MD043503E . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
• Identifier: 0011990950009 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
• Identifier: 600838 . This is a "BLUE CROSS" identifier . This identifiers is of the category "OTHER".
• Identifier: MD043503E . This is a "TRICARE FOR LIFE" identifier . This identifiers is of the category "OTHER".
• Identifier: 0279190001 . This is a "UNITED HEALTHCARE DMERC" identifier . This identifiers is of the category "OTHER".
• Identifier: 0011990950009 . This is a "MED PLUS/THREE RIVERS" identifier . This identifiers is of the category "OTHER".
• Identifier: 80155 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
• Identifier: 180037688 . This is a "UNITED HEALTHCARE" identifier . This identifiers is of the category "OTHER".
• Identifier: 0017322 . This is a "DORAL VISION SERVICES" identifier . This identifiers is of the category "OTHER".
• Identifier: 1039208 . This is a "GATEWAY HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
• Identifier: 4550PA . This is a "VISION SERVICE PLAN" identifier . This identifiers is of the category "OTHER".