Provider Demographics
NPI:1134291909
Name:GREENSBURG MEDICAL ASSOCIATES LTD
Entity Type:Organization
Organization Name:GREENSBURG MEDICAL ASSOCIATES LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:TYMOCZKO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:724-836-8400
Mailing Address - Street 1:545 RUGH ST
Mailing Address - Street 2:SUITE 5000
Mailing Address - City:GREENSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15601-5684
Mailing Address - Country:US
Mailing Address - Phone:724-836-8400
Mailing Address - Fax:724-836-8459
Practice Address - Street 1:545 RUGH ST.
Practice Address - Street 2:SUITE 5000
Practice Address - City:GREENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15601-5684
Practice Address - Country:US
Practice Address - Phone:724-836-8400
Practice Address - Fax:724-836-8459
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-15
Last Update Date:2014-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD022676E207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA2147496OtherAETNA US HEALTHCARE
PA207650OtherHEALTHAMERICA
PA416263OtherBLUE SHIELD
PA066176Medicare PIN