Provider Demographics
NPI:1942337712
Name:UPMC COMMUNITY MEDICINE INC
Entity Type:Organization
Organization Name:UPMC COMMUNITY MEDICINE INC
Other - Org Name:UPMC KEYSTONE PRIMARY CARE-DRS SHETTY & PAUL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:EHALT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:412-647-0943
Mailing Address - Street 1:4212 OLD WILLIAM PENN HWY
Mailing Address - Street 2:
Mailing Address - City:MURRYSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15668-1901
Mailing Address - Country:US
Mailing Address - Phone:724-733-1725
Mailing Address - Fax:
Practice Address - Street 1:4212 OLD WILLIAM PENN HWY
Practice Address - Street 2:
Practice Address - City:MURRYSVILLE
Practice Address - State:PA
Practice Address - Zip Code:15668-1901
Practice Address - Country:US
Practice Address - Phone:724-733-1725
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-27
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA042490Medicare ID - Type Unspecified
PA042490Medicare PIN