Provider Demographics
NPI:1619012820
Name:PITTSBURGH NEUROLOGY CONSULTANTS
Entity Type:Organization
Organization Name:PITTSBURGH NEUROLOGY CONSULTANTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:MRS
Authorized Official - First Name:BETSY
Authorized Official - Middle Name:A
Authorized Official - Last Name:GUMP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:412-856-4171
Mailing Address - Street 1:2571 MOSSIDE BLVD
Mailing Address - Street 2:SUITE 4
Mailing Address - City:MONROEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15146-3510
Mailing Address - Country:US
Mailing Address - Phone:412-856-4171
Mailing Address - Fax:412-856-8273
Practice Address - Street 1:2571 MOSSIDE BLVD
Practice Address - Street 2:SUITE 4
Practice Address - City:MONROEVILLE
Practice Address - State:PA
Practice Address - Zip Code:15146-3510
Practice Address - Country:US
Practice Address - Phone:412-856-4171
Practice Address - Fax:412-856-8273
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2010-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA022678-E2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0013968710002Medicaid
PA0013968710002Medicaid