Provider Demographics
NPI:1326078551
Name:BRENTWOOD MEDICAL ASSOCIATES
Entity Type:Organization
Organization Name:BRENTWOOD MEDICAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:VINCENT
Authorized Official - Middle Name:
Authorized Official - Last Name:LUCCHETTI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:412-882-8455
Mailing Address - Street 1:3028 BROWNSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15227-2402
Mailing Address - Country:US
Mailing Address - Phone:412-882-9455
Mailing Address - Fax:
Practice Address - Street 1:3028 BROWNSVILLE RD
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15227-2402
Practice Address - Country:US
Practice Address - Phone:412-882-9455
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA039026Medicare ID - Type Unspecified