1992793236 NPI number — DR. SANDRA ANN CROMO MD

Table of content: DR. SANDRA ANN CROMO MD (NPI 1992793236)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992793236 NPI number — DR. SANDRA ANN CROMO MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CROMO
Provider First Name:
SANDRA
Provider Middle Name:
ANN
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:
1992793236
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/07/2023
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:
412-647-8384
Provider Business Mailing Address Fax Number:
412-647-4486

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2400 CORPORATE DR
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
WEXFORD
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15090-7645
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-933-3400
Provider Business Practice Location Address Fax Number:
724-933-3455
Provider Enumeration Date:
10/11/2005

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: 207Q00000X , with the licence number:  MD041857L , 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: 001202314 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: MD041857L . This is a "MEDICAL LIC NUMBER" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 606569 . This is a "HIGHMARK" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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