Provider Demographics
NPI:1538331152
Name:ALLEGHENY CLINIC
Entity Type:Organization
Organization Name:ALLEGHENY CLINIC
Other - Org Name:ALLEGHENY NEUROLOGICAL ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PROVIDER CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:CANDICE
Authorized Official - Middle Name:
Authorized Official - Last Name:GENTILE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:412-330-5853
Mailing Address - Street 1:490 E NORTH AVE STE 500
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15212-4765
Mailing Address - Country:US
Mailing Address - Phone:412-359-8860
Mailing Address - Fax:412-359-8809
Practice Address - Street 1:490 E NORTH AVE STE 500
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15212-4765
Practice Address - Country:US
Practice Address - Phone:412-359-8860
Practice Address - Fax:412-359-8809
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-25
Last Update Date:2017-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007317140351Medicaid
PA1007317140351Medicaid