1710941976 NPI number — KATIE M EVANCHICK PA

Table of content: KATIE M EVANCHICK PA (NPI 1710941976)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710941976 NPI number — KATIE M EVANCHICK PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
EVANCHICK
Provider First Name:
KATIE
Provider Middle Name:
M
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PA
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:
1710941976
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/07/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
200 LOTHROP ST
Provider Second Line Business Mailing Address:
FORBES TOWER, SUITE 9055
Provider Business Mailing Address City Name:
PITTSBURGH
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15213-2536
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
412-647-3087
Provider Business Mailing Address Fax Number:
412-647-4486

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
200 DELAFIELD RD
Provider Second Line Business Practice Location Address:
SUITE 4010
Provider Business Practice Location Address City Name:
PITTSBURGH
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15215-3205
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
412-784-5770
Provider Business Practice Location Address Fax Number:
412-784-5776
Provider Enumeration Date:
04/14/2006

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: 363A00000X , with the licence number:  MA054773 , 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)





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