Provider Demographics
NPI:1871866541
Name:CRANBERRY ALLERGY ASTHMA AND CLINICAL IMMUNOLOGY, PLLC
Entity Type:Organization
Organization Name:CRANBERRY ALLERGY ASTHMA AND CLINICAL IMMUNOLOGY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATOR
Authorized Official - Prefix:
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:
Authorized Official - Last Name:ALBRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:724-935-1111
Mailing Address - Street 1:119 VIP DR
Mailing Address - Street 2:SUITE 204
Mailing Address - City:WEXFORD
Mailing Address - State:PA
Mailing Address - Zip Code:15090-7976
Mailing Address - Country:US
Mailing Address - Phone:724-935-1111
Mailing Address - Fax:724-704-7832
Practice Address - Street 1:119 VIP DR
Practice Address - Street 2:SUITE 204
Practice Address - City:WEXFORD
Practice Address - State:PA
Practice Address - Zip Code:15090-7976
Practice Address - Country:US
Practice Address - Phone:724-935-1111
Practice Address - Fax:724-704-7832
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-10
Last Update Date:2012-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Single Specialty