Provider Demographics
NPI:1881060648
Name:ALLEGHENY CLINIC PEDIATRICS
Entity type:Organization
Organization Name:ALLEGHENY CLINIC PEDIATRICS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CMO
Authorized Official - Prefix:
Authorized Official - First Name:DAMIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:TERNULLO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:412-221-2121
Mailing Address - Street 1:1100 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:CARNEGIE
Mailing Address - State:PA
Mailing Address - Zip Code:15106-3614
Mailing Address - Country:US
Mailing Address - Phone:412-278-5100
Mailing Address - Fax:412-278-5105
Practice Address - Street 1:1200 BROOKS LN
Practice Address - Street 2:SUITE 270
Practice Address - City:JEFFERSON HILLS
Practice Address - State:PA
Practice Address - Zip Code:15025-3747
Practice Address - Country:US
Practice Address - Phone:412-460-8111
Practice Address - Fax:412-460-8112
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-17
Last Update Date:2015-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA054576208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty