Provider Demographics
NPI:1407910342
Name:UPMC BRADDOCK
Entity Type:Organization
Organization Name:UPMC BRADDOCK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MAMMARELLA
Authorized Official - Suffix:
Authorized Official - Credentials:CFO
Authorized Official - Phone:412-636-5314
Mailing Address - Street 1:400 HOLLAND AVE
Mailing Address - Street 2:
Mailing Address - City:BRADDOCK
Mailing Address - State:PA
Mailing Address - Zip Code:15104-1599
Mailing Address - Country:US
Mailing Address - Phone:412-432-5500
Mailing Address - Fax:
Practice Address - Street 1:200 LOTHROP ST
Practice Address - Street 2:QUANTUM #1 3RD FL
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15213-2536
Practice Address - Country:US
Practice Address - Phone:412-432-5500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-21
Last Update Date:2007-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0002OtherHIGHMARK PROVIDER NUMBER
PA390128Medicare Oscar/Certification