Provider Demographics
NPI:1831108489
Name:UPMC BRADDOCK
Entity Type:Organization
Organization Name:UPMC BRADDOCK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MAMMARELLA
Authorized Official - Suffix:
Authorized Official - Credentials:CFO
Authorized Official - Phone:412-636-5314
Mailing Address - Street 1:PO BOX 382007
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15250-8007
Mailing Address - Country:US
Mailing Address - Phone:412-432-5500
Mailing Address - Fax:
Practice Address - Street 1:400 HOLLAND AVE
Practice Address - Street 2:
Practice Address - City:BRADDOCK
Practice Address - State:PA
Practice Address - Zip Code:15104-1599
Practice Address - Country:US
Practice Address - Phone:412-432-5500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-05
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA35OtherUPMC FOR YOU NUMBER
NJ4196007Medicaid
PA0006490105OtherAETNA US HEALTHCARE NUMBE
PA0080000OtherAETNA HMO NUMBER
NY00814902Medicaid
WV0101249Medicaid
PA390176OtherHEALTHAMERICA NUMBER
OH7061889Medicaid
PA1007360690006Medicaid
PA0002OtherHIGHMARK PROVIDER NUMBER
PA00000060222OtherMEDPLUS NUMBER
PA1005242OtherGATEWAY NUMBER
PA1007360690006OtherION HEALTHCARE NUMBER
PA35OtherUPMC HEALTH PLAN NUMBER
PA1007360690006OtherION HEALTHCARE NUMBER
PA390176OtherHEALTHAMERICA NUMBER
OH7061889Medicaid
PA=========OtherCHAMPUS NUMBER