Provider Demographics
NPI:1760571475
Name:PEDIATRIC & ADULT ALLERGY & ASTHMA
Entity Type:Organization
Organization Name:PEDIATRIC & ADULT ALLERGY & ASTHMA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:WN
Authorized Official - Last Name:WEBER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:412-361-8355
Mailing Address - Street 1:5750 CENTRE AVE
Mailing Address - Street 2:270
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15206-3721
Mailing Address - Country:US
Mailing Address - Phone:412-361-8355
Mailing Address - Fax:412-361-8616
Practice Address - Street 1:5750 CENTRE AVE
Practice Address - Street 2:270
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15206-3721
Practice Address - Country:US
Practice Address - Phone:412-361-8355
Practice Address - Fax:412-361-8616
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-12
Last Update Date:2010-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD190953174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0015301370003Medicaid
PA0015301370003Medicaid
PA777663Medicare ID - Type Unspecified
PAC30221Medicare UPIN