Provider Demographics
NPI:1821472812
Name:ALLEGHENY CLINIC
Entity Type:Organization
Organization Name:ALLEGHENY CLINIC
Other - Org Name:AHN FOX CHAPEL DERMATOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PROVIDER CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:JANE
Authorized Official - Middle Name:
Authorized Official - Last Name:WETZEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:412-330-5233
Mailing Address - Street 1:241 FREEPORT RD
Mailing Address - Street 2:
Mailing Address - City:ASPINWALL
Mailing Address - State:PA
Mailing Address - Zip Code:15215-3035
Mailing Address - Country:US
Mailing Address - Phone:412-784-8541
Mailing Address - Fax:412-784-8225
Practice Address - Street 1:241 FREEPORT RD
Practice Address - Street 2:
Practice Address - City:ASPINWALL
Practice Address - State:PA
Practice Address - Zip Code:15215-3035
Practice Address - Country:US
Practice Address - Phone:412-784-8541
Practice Address - Fax:412-784-8225
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-20
Last Update Date:2015-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural DermatologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA030490Medicare PIN