Provider Demographics
NPI:1760459051
Name:HERMITAGE INTERNAL MEDICINE GROUP
Entity Type:Organization
Organization Name:HERMITAGE INTERNAL MEDICINE GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ALFRED
Authorized Official - Middle Name:J
Authorized Official - Last Name:JOSEPH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:724-981-5613
Mailing Address - Street 1:2151 SHENANGO VALLEY FWY
Mailing Address - Street 2:
Mailing Address - City:HERMITAGE
Mailing Address - State:PA
Mailing Address - Zip Code:16148-2586
Mailing Address - Country:US
Mailing Address - Phone:724-981-5613
Mailing Address - Fax:724-981-4790
Practice Address - Street 1:2151 SHENANGO VALLEY FWY
Practice Address - Street 2:
Practice Address - City:HERMITAGE
Practice Address - State:PA
Practice Address - Zip Code:16148-2586
Practice Address - Country:US
Practice Address - Phone:724-981-5613
Practice Address - Fax:724-981-4790
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007406420007Medicaid
25788745OtherAETNA HEALTH CARE
PAHE101854OtherHIGHMARK
PA1007406420007Medicaid