1487627998 NPI number — DR. STEVEN GERARD DOCIMO M.D.

Table of content: DR. STEVEN GERARD DOCIMO M.D. (NPI 1487627998)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487627998 NPI number — DR. STEVEN GERARD DOCIMO M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DOCIMO
Provider First Name:
STEVEN
Provider Middle Name:
GERARD
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

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:
1487627998
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/23/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4401 PENN AVE
Provider Second Line Business Mailing Address:
SUITE 6400 AAB
Provider Business Mailing Address City Name:
PITTSBURGH
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15224-1334
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
412-692-7288
Provider Business Mailing Address Fax Number:
412-692-5800

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4401 PENN AVE
Provider Second Line Business Practice Location Address:
4TH FL FACULTY PAVILION
Provider Business Practice Location Address City Name:
PITTSBURGH
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15224-1334
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
412-692-7467
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/08/2006

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: 174400000X , with the licence number:  MD071827L , 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: 001627781 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".