Provider Demographics
NPI:1598037004
Name:UPMC COMMUNITY MEDICINE INC
Entity Type:Organization
Organization Name:UPMC COMMUNITY MEDICINE INC
Other - Org Name:NORTHWEST PENNSYLVANIA UROLOGY ASSOCIATES-UPMC
Other - Org Type:Other Name
Authorized Official - Title/Position:SR.DIRECTOR
Authorized Official - Prefix:MR
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 1:2623 WILMINGTON RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:NEW CASTLE
Mailing Address - State:PA
Mailing Address - Zip Code:16105-1529
Mailing Address - Country:US
Mailing Address - Phone:724-658-7790
Mailing Address - Fax:724-658-5767
Practice Address - Street 1:2623 WILMINGTON RD
Practice Address - Street 2:SUITE B
Practice Address - City:NEW CASTLE
Practice Address - State:PA
Practice Address - Zip Code:16105-1529
Practice Address - Country:US
Practice Address - Phone:724-658-7790
Practice Address - Fax:724-658-5767
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-30
Last Update Date:2012-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA042490Medicare PIN