Provider Demographics
NPI:1023060779
Name:PLASTIC SURGICAL ASSOCIATES OF PITTSBURGH, P.C.
Entity type:Organization
Organization Name:PLASTIC SURGICAL ASSOCIATES OF PITTSBURGH, P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:W
Authorized Official - Last Name:BRAGDON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:412-572-6164
Mailing Address - Street 1:PO BOX 719
Mailing Address - Street 2:
Mailing Address - City:MONROEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15146-0719
Mailing Address - Country:US
Mailing Address - Phone:412-457-0175
Mailing Address - Fax:412-457-0179
Practice Address - Street 1:1050 BOWER HILL RD
Practice Address - Street 2:SUITE 105
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15243-1800
Practice Address - Country:US
Practice Address - Phone:412-572-6164
Practice Address - Fax:412-572-6156
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-17
Last Update Date:2016-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1015516860001Medicaid
PA102294Medicare PIN