Provider Demographics
NPI:1598169229
Name:ALLEGHENY CLINIC
Entity Type:Organization
Organization Name:ALLEGHENY CLINIC
Other - Org Name:AGH RADIATION ONCOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR PROVIDER ENROLLMENT
Authorized Official - Prefix:
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:
Authorized Official - Last Name:NOEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:412-330-5861
Mailing Address - Street 1:12311 PERRY HIGHWAY
Mailing Address - Street 2:
Mailing Address - City:WEXFORD
Mailing Address - State:PA
Mailing Address - Zip Code:15090-8344
Mailing Address - Country:US
Mailing Address - Phone:412-359-4068
Mailing Address - Fax:412-359-6732
Practice Address - Street 1:12311 PERRY HIGHWAY
Practice Address - Street 2:
Practice Address - City:WEXFORD
Practice Address - State:PA
Practice Address - Zip Code:15090-8344
Practice Address - Country:US
Practice Address - Phone:412-359-4068
Practice Address - Fax:412-359-6732
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-09
Last Update Date:2020-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA2085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA041456Medicare PIN