1487673844 NPI number — MS. ANN CATHERINE WILDER LCSW

Table of content: TIMOTHY FANG PHARM.D. (NPI 1235925660)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487673844 NPI number — MS. ANN CATHERINE WILDER LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WILDER
Provider First Name:
ANN
Provider Middle Name:
CATHERINE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LCSW
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:
1487673844
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/11/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1530 VANCE AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CORAOPOLIS
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15108-2130
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
325-271-8707
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
UPMC PAIN MEDICINE
Provider Second Line Business Practice Location Address:
UPMC ST. MARGARET'S HOSPITAL
Provider Business Practice Location Address City Name:
PITTSBURGH
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15215
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
412-784-5119
Provider Business Practice Location Address Fax Number:
412-784-5228
Provider Enumeration Date:
07/18/2006

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: 1041C0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X , with the licence number: 36157 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X , with the licence number: CW020952 , 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: 163974202 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 86477Q . This is a "BLUE CROSS BLUE SHEILD" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: P00144488 . This is a "RAIL ROAD" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".