Provider Demographics
NPI:1598980393
Name:NOBLECARE PRIMARY CARE CENTER,INC
Entity Type:Organization
Organization Name:NOBLECARE PRIMARY CARE CENTER,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KHATTAR
Authorized Official - Middle Name:
Authorized Official - Last Name:AIZOOKY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:412-563-7100
Mailing Address - Street 1:301 CASTLE SHANNON BLVD
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15234-1403
Mailing Address - Country:US
Mailing Address - Phone:412-563-7100
Mailing Address - Fax:412-563-6915
Practice Address - Street 1:301 CASTLE SHANNON BLVD
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15234-1403
Practice Address - Country:US
Practice Address - Phone:412-563-7100
Practice Address - Fax:412-563-6915
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-16
Last Update Date:2007-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD069313L174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAH19480Medicare UPIN
PA039177Medicare ID - Type Unspecified