Provider Demographics
NPI:1396171377
Name:UPMC COMMUNITY MEDICINE INC
Entity type:Organization
Organization Name:UPMC COMMUNITY MEDICINE INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SR.DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:EHALT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:412-647-0943
Mailing Address - Street 1:510 S AIKEN AVE
Mailing Address - Street 2:SUITE EG-01
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15232-1505
Mailing Address - Country:US
Mailing Address - Phone:412-683-1717
Mailing Address - Fax:412-683-1773
Practice Address - Street 1:510 S AIKEN AVE
Practice Address - Street 2:SUITE EG-01
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15232-1505
Practice Address - Country:US
Practice Address - Phone:412-683-1717
Practice Address - Fax:412-683-1773
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-23
Last Update Date:2013-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA042490Medicare PIN