Provider Demographics
NPI:1184653636
Name:FAILLA, JACK PAUL (MD)
Entity Type:Individual
Prefix:
First Name:JACK
Middle Name:PAUL
Last Name:FAILLA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5900 CORPORATE DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15237-7005
Mailing Address - Country:US
Mailing Address - Phone:412-369-4000
Mailing Address - Fax:
Practice Address - Street 1:5900 CORPORATE DR
Practice Address - Street 2:SUITE 200
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15237-7004
Practice Address - Country:US
Practice Address - Phone:412-369-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2014-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD024200E207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA018555Medicare ID - Type Unspecified
PAB33146Medicare UPIN