Provider Demographics
NPI:1679638985
Name:SEWICKLEY VALLEY RHEUMATOLOGY LLC
Entity Type:Organization
Organization Name:SEWICKLEY VALLEY RHEUMATOLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:
Authorized Official - First Name:GERI
Authorized Official - Middle Name:L
Authorized Official - Last Name:BACU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:724-266-2447
Mailing Address - Street 1:1196 MERCHANT STREET
Mailing Address - Street 2:
Mailing Address - City:AMBRIDGE
Mailing Address - State:PA
Mailing Address - Zip Code:15003-2335
Mailing Address - Country:US
Mailing Address - Phone:724-266-2447
Mailing Address - Fax:724-266-2920
Practice Address - Street 1:1196 MERCHANT STREET
Practice Address - Street 2:
Practice Address - City:AMBRIDGE
Practice Address - State:PA
Practice Address - Zip Code:15003-2335
Practice Address - Country:US
Practice Address - Phone:724-266-2447
Practice Address - Fax:724-266-2920
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD049189L207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1633767OtherBLUE SHIELD
PA1633767OtherBLUE SHIELD
PA85197Medicare ID - Type Unspecified
PA85797Medicare ID - Type Unspecified