Provider Demographics
NPI:1205073202
Name:PIERCE SOFFRONOFF, MD., PC
Entity type:Organization
Organization Name:PIERCE SOFFRONOFF, MD., PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PIERCE
Authorized Official - Middle Name:
Authorized Official - Last Name:SOFFRONOFF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:412-828-6870
Mailing Address - Street 1:414-416 ALLEGHENY RIVER BLVD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:OAKMONT
Mailing Address - State:PA
Mailing Address - Zip Code:15139-1735
Mailing Address - Country:US
Mailing Address - Phone:412-828-6870
Mailing Address - Fax:412-828-6871
Practice Address - Street 1:414-416 ALLEGHENY RIVER BLVD
Practice Address - Street 2:SUITE 204
Practice Address - City:OAKMONT
Practice Address - State:PA
Practice Address - Zip Code:15139-1735
Practice Address - Country:US
Practice Address - Phone:412-828-6870
Practice Address - Fax:412-828-6871
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-13
Last Update Date:2009-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD 016655 E174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAB40228Medicare UPIN
PA158624Medicare PIN