Provider Demographics
NPI:1124217401
Name:BENEDUM GERIATRIC CENTER
Entity Type:Organization
Organization Name:BENEDUM GERIATRIC CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ANNE
Authorized Official - Middle Name:B
Authorized Official - Last Name:NEWMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:412-692-4200
Mailing Address - Street 1:200 LOTHROP ST
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15213-2536
Mailing Address - Country:US
Mailing Address - Phone:412-692-4622
Mailing Address - Fax:412-692-4225
Practice Address - Street 1:130 N BELLEFIELD AVE
Practice Address - Street 2:FIFTH FLOOR, ROOM 532
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15213-2695
Practice Address - Country:US
Practice Address - Phone:412-383-1931
Practice Address - Fax:412-383-1308
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-23
Last Update Date:2007-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD030672E174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAC28987OtherUPIN
PA0011419800001Medicaid
PA0011419800001Medicaid