Provider Demographics
NPI:1497721146
Name:BACKSTROM, JAMES W (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:W
Last Name:BACKSTROM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 LIBERTY AVE STE 2000
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15222-1029
Mailing Address - Country:US
Mailing Address - Phone:412-230-8200
Mailing Address - Fax:412-202-8638
Practice Address - Street 1:401 LIBERTY AVE STE 2000
Practice Address - Street 2:THREE GATEWAY CENTER, 20TH FLOOR
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15222-1029
Practice Address - Country:US
Practice Address - Phone:412-223-2272
Practice Address - Fax:412-281-6320
Is Sole Proprietor?:No
Enumeration Date:2006-02-23
Last Update Date:2019-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD4185262085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
1387766OtherHIGHMARK
PA0018975900009Medicaid
PA0018975900010Medicaid
PAP00663923OtherRAILROAD MEDICARE
PA1387766OtherHIGHMARK BCBS
PAP00663923OtherRAILROAD MEDICARE
PAG02054Medicare UPIN
PA054890Medicare PIN