Basic Information
| Provider Information | |||||||||
| NPI: | 1639340755 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NAUMOVSKI | ||||||||
| FirstName: | JOHN | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2 HOT METAL ST | ||||||||
| Address2: | QUANTUM ONE, SUITE 001 | ||||||||
| City: | PITTSBURGH | ||||||||
| State: | PA | ||||||||
| PostalCode: | 152032348 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4126473087 | ||||||||
| FaxNumber: | 4124325640 | ||||||||
| Practice Location | |||||||||
| Address1: | 5200 CENTRE AVE | ||||||||
| Address2: | SUITE 405 | ||||||||
| City: | PITTSBURGH | ||||||||
| State: | PA | ||||||||
| PostalCode: | 152321300 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4126232700 | ||||||||
| FaxNumber: | 4126231235 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/17/2008 | ||||||||
| LastUpdateDate: | 12/19/2016 | ||||||||
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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 | 390200000X | MD433077 | PA | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207Q00000X | MD433077 | PA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1022092500 | 05 | PA | MEDICAID |