1336206176 NPI number — MELISSA K RADUE MA CCCA

Table of content: MELISSA K RADUE MA CCCA (NPI 1336206176)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336206176 NPI number — MELISSA K RADUE MA CCCA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RADUE
Provider First Name:
MELISSA
Provider Middle Name:
K
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MA CCCA
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:
1336206176
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/02/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1300 OXFORD DRIVE
Provider Second Line Business Mailing Address:
SUITE LLC
Provider Business Mailing Address City Name:
BETHEL PARK
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15102
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
412-831-7570
Provider Business Mailing Address Fax Number:
412-831-7073

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1300 OXFORD DRIVE
Provider Second Line Business Practice Location Address:
SUITE LLC
Provider Business Practice Location Address City Name:
BETHEL PARK
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15102
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
412-831-7570
Provider Business Practice Location Address Fax Number:
412-831-7073
Provider Enumeration Date:
01/02/2007

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: 231H00000X , with the licence number:  AT005938 , 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: 091426G2D . This is a "GROUP MEMBER PTAN" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: RA1737857 . This is a "HIGHMARK BCBS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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