Provider Demographics
NPI:1215231683
Name:UPMC COMMUNITY MEDICINE INC
Entity Type:Organization
Organization Name:UPMC COMMUNITY MEDICINE INC
Other - Org Name:GATEWAY MEDICAL GROUP-UPMC
Other - Org Type:Other Name
Authorized Official - Title/Position:SR.DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:T
Authorized Official - Last Name:EHALT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:412-647-0943
Mailing Address - Street 1:1100 WASHINGTON AVE
Mailing Address - Street 2:SUITE 115
Mailing Address - City:CARNEGIE
Mailing Address - State:PA
Mailing Address - Zip Code:15106-3614
Mailing Address - Country:US
Mailing Address - Phone:412-279-8940
Mailing Address - Fax:412-279-8871
Practice Address - Street 1:1100 WASHINGTON AVE
Practice Address - Street 2:SUITE 115
Practice Address - City:CARNEGIE
Practice Address - State:PA
Practice Address - Zip Code:15106-3614
Practice Address - Country:US
Practice Address - Phone:412-279-8940
Practice Address - Fax:412-279-8871
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-29
Last Update Date:2010-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA042490Medicare PIN