Provider Demographics
NPI:1588810444
Name:RENAISSANCE FAMILY PRACTICE-UPMC,INC
Entity Type:Organization
Organization Name:RENAISSANCE FAMILY PRACTICE-UPMC,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:EHALT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:412-647-0943
Mailing Address - Street 1:200 DELAFIELD RD
Mailing Address - Street 2:SUITE 2030
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15215-3205
Mailing Address - Country:US
Mailing Address - Phone:412-782-2101
Mailing Address - Fax:
Practice Address - Street 1:200 DELAFIELD RD
Practice Address - Street 2:SUITE 2030
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15215-3205
Practice Address - Country:US
Practice Address - Phone:412-782-2101
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-12
Last Update Date:2008-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty