Provider Demographics
NPI:1538167804
Name:KELMINSON, STEPHEN (MD)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:
Last Name:KELMINSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 LIBERTY AVE STE 2000
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15222-1029
Mailing Address - Country:US
Mailing Address - Phone:412-230-8200
Mailing Address - Fax:412-202-8638
Practice Address - Street 1:401 LIBERTY AVE STE 2000
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15222
Practice Address - Country:US
Practice Address - Phone:412-230-8200
Practice Address - Fax:412-202-8638
Is Sole Proprietor?:No
Enumeration Date:2005-07-12
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD058309L2085R0202X, 2085R0204X
KY479452085R0202X, 2085R0204X
FLME1425692085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA000456731OtherBC BS
OH0891147Medicaid
PA0013049780003Medicaid
PA300064301OtherRAILROAD MEDICARE
PA000456731OtherBC BS
PA0013049780003Medicaid