Basic Information
Provider Information
NPI: 1780145334
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: RACE
FirstName: NICHOLAS
MiddleName: S
NamePrefix: DR.
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 3600 FORBES AVENUE
Address2: FORBES TOWER - PLAZA LEVEL SUITE 140
City: PITTSBURGH
State: PA
PostalCode: 15213
CountryCode: US
TelephoneNumber: 4126476340
FaxNumber: 4126475809
Practice Location
Address1: 1400 LOCUST STREET ERMIRE
Address2: SUITE 11516
City: PITTSBURGH
State: PA
PostalCode: 15219
CountryCode: US
TelephoneNumber: 4122328949
FaxNumber: 4122327535
Other Information
ProviderEnumerationDate: 03/27/2019
LastUpdateDate: 03/31/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 03/31/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
390200000X  Y Student, Health CareStudent in an Organized Health Care Education/Training Program 

No ID Information.


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