Basic Information
| Provider Information | |||||||||
| NPI: | 1568600146 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | UPMC COMMUNITY MEDICINE INC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | ELIZABETH TOWNSHIP FAMILY MEDICINE-UPMC | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 300 SCENERY DR | ||||||||
| Address2: | |||||||||
| City: | ELIZABETH | ||||||||
| State: | PA | ||||||||
| PostalCode: | 150372068 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4126473087 | ||||||||
| FaxNumber: | 4126474050 | ||||||||
| Practice Location | |||||||||
| Address1: | 300 SCENERY DR | ||||||||
| Address2: | |||||||||
| City: | ELIZABETH | ||||||||
| State: | PA | ||||||||
| PostalCode: | 150372068 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4126473087 | ||||||||
| FaxNumber: | 4126474050 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/04/2009 | ||||||||
| LastUpdateDate: | 02/04/2009 | ||||||||
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| AuthorizedOfficialLastName: | EHALT | ||||||||
| AuthorizedOfficialFirstName: | MARK | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 4126470943 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.