1831185032 NPI number — BRUCE A MACLEOD MD

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831185032 NPI number — BRUCE A MACLEOD MD

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

MACLEOD

Provider First Name:

BRUCE

Provider Middle Name:

A

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

MD

Provider Gender Code:

M

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:

1831185032

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

05/19/2020

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

1515 MOHICAN DR

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

PITTSBURGH

Provider Business Mailing Address State Name:

PA

Provider Business Mailing Address Postal Code:

15228-1615

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

412-849-3671

Provider Business Mailing Address Fax Number:

412-232-5768

Provider First Line Business Practice Location Address:

3290 SAW MILL RUN BLVD

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

BRENTWOOD

Provider Business Practice Location Address State Name:

PA

Provider Business Practice Location Address Postal Code:

15227-2318

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

412-437-2600

Provider Business Practice Location Address Fax Number:

Provider Enumeration Date:

09/22/2005

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 207P00000X , with the licence number:  MD23896 , registered in the state of ME ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 207P00000X , with the licence number: MD044492E , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
• Taxonomy code: 207P00000X , with the licence number: 35.136706 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

• Identifier: 0011895170001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
• Identifier: 1513379 . This is a "GATEWAY" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
• Identifier: 250350 . This is a "UPMC" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
• Identifier: 0505638 . This is a "AETNA PVN" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
• Identifier: 567777JK6 . This is a "PA MCR GROUP PTAN" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
• Identifier: 930009485 . This is a "RR MEDICARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
• Identifier: 62746 . This is a "UNISON" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
• Identifier: 594424 . This is a "BCBS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
• Identifier: 5608033 . This is a "AETNA PIN" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".