Provider Demographics
NPI:1518943521
Name:PLUM PEDIATRICS PC
Entity Type:Organization
Organization Name:PLUM PEDIATRICS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:
Authorized Official - Last Name:CALABRESE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:724-327-7586
Mailing Address - Street 1:781 PINE VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15239-2842
Mailing Address - Country:US
Mailing Address - Phone:724-327-7586
Mailing Address - Fax:724-327-9562
Practice Address - Street 1:781 PINE VALLEY DR
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15239-2842
Practice Address - Country:US
Practice Address - Phone:724-327-7586
Practice Address - Fax:724-327-9562
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-21
Last Update Date:2007-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD051024L208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0014969000OtherINDEPENDENCE BLUE SHIELD
PA0018313820001Medicaid
128877OtherHEALTH AMERICA
PA917554OtherHIGHMARK BLUE SHIELD
5267460OtherAETNA PPO
62106OtherUNISON HEALTH PLAN
1027145OtherGATEWAY HEALTH PLAN
556984OtherAETNA HMO