Provider Demographics
NPI:1326436619
Name:ALLEGHENY CLINIC PEDIATRICS
Entity Type:Organization
Organization Name:ALLEGHENY CLINIC PEDIATRICS
Other - Org Name:ALLEGHENY CLINIC
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR PROVIDER ENROLLMENT
Authorized Official - Prefix:
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:
Authorized Official - Last Name:NOEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:412-770-6871
Mailing Address - Street 1:1100 WASHINGTON AVE STE 215
Mailing Address - Street 2:
Mailing Address - City:CARNEGIE
Mailing Address - State:PA
Mailing Address - Zip Code:15106-3616
Mailing Address - Country:US
Mailing Address - Phone:412-596-8408
Mailing Address - Fax:412-278-5105
Practice Address - Street 1:12311 PERRY HWY STE D
Practice Address - Street 2:
Practice Address - City:WEXFORD
Practice Address - State:PA
Practice Address - Zip Code:15090-8344
Practice Address - Country:US
Practice Address - Phone:878-332-4920
Practice Address - Fax:878-332-4921
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-08
Last Update Date:2023-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1030106760001Medicaid