Provider Demographics
NPI:1194702464
Name:USDL PITTSBURGH, INC.
Entity type:Organization
Organization Name:USDL PITTSBURGH, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:
Authorized Official - First Name:ROBBIE
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBERTSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-323-2594
Mailing Address - Street 1:23110 STATE RD 54
Mailing Address - Street 2:PMB 292
Mailing Address - City:LUTZ
Mailing Address - State:FL
Mailing Address - Zip Code:33549-4566
Mailing Address - Country:US
Mailing Address - Phone:352-578-2055
Mailing Address - Fax:813-977-0143
Practice Address - Street 1:665 RODI RD
Practice Address - Street 2:TWO RODI PLAZA, SUITE 103
Practice Address - City:PENN HILLS
Practice Address - State:PA
Practice Address - Zip Code:15235-4566
Practice Address - Country:US
Practice Address - Phone:412-241-7380
Practice Address - Fax:412-241-1395
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-28
Last Update Date:2021-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0011815460001Medicaid
PAP00056706OtherRAILROAD MEDICARE
PA0011815460001Medicaid