Provider Demographics
NPI:1932172475
Name:COLODNY, STEPHANIE (MD)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:COLODNY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1910 COCHRAN RD
Mailing Address - Street 2:SUITE 490
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15220-1203
Mailing Address - Country:US
Mailing Address - Phone:412-531-2902
Mailing Address - Fax:
Practice Address - Street 1:3928 WASHINGTON RD
Practice Address - Street 2:SUITE 220
Practice Address - City:MC MURRAY
Practice Address - State:PA
Practice Address - Zip Code:15317-2537
Practice Address - Country:US
Practice Address - Phone:724-941-8877
Practice Address - Fax:724-941-4745
Is Sole Proprietor?:No
Enumeration Date:2006-02-07
Last Update Date:2015-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD-035750E174400000X
PAMD035750E207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
110102925OtherRAILROAD MEDICARE PTAN
PA0015176270002Medicaid
PA472020JFZMedicare ID - Type Unspecified
PA0015176270002Medicaid