Provider Demographics
NPI:1437580081
Name:TRI-STATE PULMONARY MEDICAL PRACTICE
Entity Type:Organization
Organization Name:TRI-STATE PULMONARY MEDICAL PRACTICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:A
Authorized Official - Last Name:LARACUENTE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:724-728-5995
Mailing Address - Street 1:3468 BRODHEAD RD STE 11
Mailing Address - Street 2:
Mailing Address - City:MONACA
Mailing Address - State:PA
Mailing Address - Zip Code:15061-3149
Mailing Address - Country:US
Mailing Address - Phone:724-728-5995
Mailing Address - Fax:724-728-6705
Practice Address - Street 1:3468 BRODHEAD RD STE 11
Practice Address - Street 2:
Practice Address - City:MONACA
Practice Address - State:PA
Practice Address - Zip Code:15061-3149
Practice Address - Country:US
Practice Address - Phone:724-728-5995
Practice Address - Fax:724-728-6705
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-09
Last Update Date:2021-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty