Provider Demographics
NPI:1831143403
Name:ALLEGHENY CLINIC MEDICAL ONCOLOGY
Entity type:Organization
Organization Name:ALLEGHENY CLINIC MEDICAL ONCOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:G
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:LONG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:412-622-0290
Mailing Address - Street 1:247 MOREWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15213-1861
Mailing Address - Country:US
Mailing Address - Phone:412-770-1826
Mailing Address - Fax:412-681-7605
Practice Address - Street 1:247 MOREWOOD AVE
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15213-1861
Practice Address - Country:US
Practice Address - Phone:412-770-1826
Practice Address - Fax:412-681-7605
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WEST PENN ALLEGHENY HEALTH SYSTEM, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-19
Last Update Date:2016-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA207RH0003X, 207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1009810470001Medicaid
PA075824Medicare PIN