1356342729 NPI number — DR. CRYSTAL LYNN MCKENRICK MD

Table of content: DR. CRYSTAL LYNN MCKENRICK MD (NPI 1356342729)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356342729 NPI number — DR. CRYSTAL LYNN MCKENRICK MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCKENRICK
Provider First Name:
CRYSTAL
Provider Middle Name:
LYNN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1356342729
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/23/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
320 E NORTH AVE
Provider Second Line Business Mailing Address:
AGH EMERGENCY ASSOCS
Provider Business Mailing Address City Name:
PITTSBURGH
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15212-4756
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
412-359-4138
Provider Business Mailing Address Fax Number:
412-359-8874

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 S JACKSON AVE
Provider Second Line Business Practice Location Address:
AGH SUBURBAN CAMPUS AGH EMERG ASSOCS
Provider Business Practice Location Address City Name:
PITTSBURGH
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15202-3428
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
412-734-6100
Provider Business Practice Location Address Fax Number:
412-734-6932
Provider Enumeration Date:
08/09/2005

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: 207P00000X , with the licence number:  MD421020 , 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: 2657138 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0019599050001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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