Provider Demographics
NPI:1073539284
Name:SSOP
Entity Type:Organization
Organization Name:SSOP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SARA
Authorized Official - Middle Name:A
Authorized Official - Last Name:IEZZI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:724-527-9525
Mailing Address - Street 1:1400 LOCUST ST
Mailing Address - Street 2:SUITE 6538
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15219-5114
Mailing Address - Country:US
Mailing Address - Phone:724-527-9525
Mailing Address - Fax:724-527-9683
Practice Address - Street 1:1400 LOCUST ST
Practice Address - Street 2:SUITE 6538
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15219-5114
Practice Address - Country:US
Practice Address - Phone:724-527-9525
Practice Address - Fax:724-527-9683
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-14
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA=========OtherTAX ID
PA026141Medicare PIN