Basic Information
| Provider Information | |||||||||
| NPI: | 1366429631 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SEWICKLEY VALLEY PEDIATRICS & ADOLESCENT MEDICINE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 701 BROAD ST | ||||||||
| Address2: | SUITE 422 | ||||||||
| City: | SEWICKLEY | ||||||||
| State: | PA | ||||||||
| PostalCode: | 151431652 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4127418700 | ||||||||
| FaxNumber: | 4127413710 | ||||||||
| Practice Location | |||||||||
| Address1: | 701 BROAD ST | ||||||||
| Address2: | SUITE 422 | ||||||||
| City: | SEWICKLEY | ||||||||
| State: | PA | ||||||||
| PostalCode: | 151431652 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4127418700 | ||||||||
| FaxNumber: | 4127413710 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/28/2005 | ||||||||
| LastUpdateDate: | 12/08/2019 | ||||||||
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| AuthorizedOfficialLastName: | GRAFF | ||||||||
| AuthorizedOfficialFirstName: | DANIEL | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | PRES/SVPAM PC | ||||||||
| AuthorizedOfficialTelephone: | 4127418700 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 12/08/2019 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.