Provider Demographics
NPI:1649321316
Name:PREFERRED PRIMARY CARE PHYSICIANS
Entity type:Organization
Organization Name:PREFERRED PRIMARY CARE PHYSICIANS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:R
Authorized Official - Last Name:ERHARD
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:412-531-2902
Mailing Address - Street 1:701 TECHNOLOGY DR STE 150
Mailing Address - Street 2:
Mailing Address - City:CANONSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15317-9531
Mailing Address - Country:US
Mailing Address - Phone:412-531-2902
Mailing Address - Fax:412-531-2948
Practice Address - Street 1:102 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:CARNEGIE
Practice Address - State:PA
Practice Address - Zip Code:15106-2446
Practice Address - Country:US
Practice Address - Phone:412-279-0320
Practice Address - Fax:412-279-8703
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-16
Last Update Date:2023-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0009406870002Medicaid
PAB40056Medicare UPIN
PA0009406870002Medicaid