Basic Information
| Provider Information | |||||||||
| NPI: | 1407821945 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PILKONIS | ||||||||
| FirstName: | PAUL | ||||||||
| MiddleName: | A | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | PHD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 200 LOTHROP STREET | ||||||||
| Address2: | SUITE 9055, FORBES TOWER | ||||||||
| City: | PITTSBURGH | ||||||||
| State: | PA | ||||||||
| PostalCode: | 152132536 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4126473087 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 3811 O'HARA STREET | ||||||||
| Address2: | SUITE 1135-E | ||||||||
| City: | PITTSBURGH | ||||||||
| State: | PA | ||||||||
| PostalCode: | 15213 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4126241000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/20/2006 | ||||||||
| LastUpdateDate: | 12/16/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | PS003175L | PA | N | Other Service Providers | Specialist | 103T00000X | PS003175L | PA | Y | Behavioral Health & Social Service Providers | Psychologist |
ID Information
| ID | Type | State | Issuer | Description | 101415684 | 05 | PA | MEDICAID |