Provider Demographics
NPI:1760468037
Name:ADVANCED KIDNEY CARE MEDICAL ASSOCIATES, P.C.
Entity Type:Organization
Organization Name:ADVANCED KIDNEY CARE MEDICAL ASSOCIATES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANGELO
Authorized Official - Middle Name:D
Authorized Official - Last Name:LUPARIELLO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:412-683-7560
Mailing Address - Street 1:372 N CRAIG ST STE 101
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15213-1245
Mailing Address - Country:US
Mailing Address - Phone:412-683-7560
Mailing Address - Fax:412-683-6992
Practice Address - Street 1:372 N CRAIG ST STE 101
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15213-1245
Practice Address - Country:US
Practice Address - Phone:412-683-7560
Practice Address - Fax:412-683-6992
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-19
Last Update Date:2021-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PACC9412OtherMEDICARE RAIL ROAD
WV3810006120Medicaid
PA0011554570012Medicaid
PA539926Medicare PIN
PA0011554570012Medicaid