Provider Demographics
NPI:1952355323
Name:MCNULTY, LARRY P (MD)
Entity type:Individual
Prefix:
First Name:LARRY
Middle Name:P
Last Name:MCNULTY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:147 TOWNE SQUARE WAY
Mailing Address - Street 2:BRENTWOOD TOWNE SQUARE
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15227-3254
Mailing Address - Country:US
Mailing Address - Phone:412-942-1085
Mailing Address - Fax:412-865-3035
Practice Address - Street 1:147 TOWNE SQUARE WAY
Practice Address - Street 2:BRENTWOOD TOWNE SQUARE
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15227-3254
Practice Address - Country:US
Practice Address - Phone:412-942-1085
Practice Address - Fax:412-865-3035
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2012-11-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD032820E207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2850982Medicaid
WV3810011653Medicaid
PA0014820850030Medicaid
WV3810011653Medicaid
PAB37500Medicare UPIN