Provider Demographics
NPI:1326015538
Name:UPMC/CONEMAUGH CANCER CENTER
Entity Type:Organization
Organization Name:UPMC/CONEMAUGH CANCER CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT - CANCER SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:E
Authorized Official - Last Name:BOGOSTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:412-692-2451
Mailing Address - Street 1:2 HOT METAL ST
Mailing Address - Street 2:QUANTUM ONE, N430
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15203-2348
Mailing Address - Country:US
Mailing Address - Phone:412-432-7706
Mailing Address - Fax:412-432-7691
Practice Address - Street 1:337 SOMERSET ST
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15901-2541
Practice Address - Country:US
Practice Address - Phone:814-534-4724
Practice Address - Fax:814-536-5135
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-07
Last Update Date:2008-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Multi-Specialty
No207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1734906OtherHIGHMARK
PA1013377930001Medicaid
PA091633UA0Medicare PIN
PA1734906OtherHIGHMARK