Provider Demographics
NPI:1194925107
Name:PITTSBURGH NORTH CARDIOLOGY ASSOC
Entity type:Organization
Organization Name:PITTSBURGH NORTH CARDIOLOGY ASSOC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RUBY
Authorized Official - Middle Name:
Authorized Official - Last Name:MARCOCELLI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:412-788-4995
Mailing Address - Street 1:660 LINCOLN AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:BELLEVUE
Mailing Address - State:PA
Mailing Address - Zip Code:15202-3426
Mailing Address - Country:US
Mailing Address - Phone:412-761-4700
Mailing Address - Fax:412-766-8152
Practice Address - Street 1:660 LINCOLN AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:BELLEVUE
Practice Address - State:PA
Practice Address - Zip Code:15202-3426
Practice Address - Country:US
Practice Address - Phone:412-761-4700
Practice Address - Fax:412-766-8152
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-19
Last Update Date:2012-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA207Q00000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA00079075900008Medicaid
000000060053OtherUNISON
PACC1531OtherRAILROAD MEDICARE
PA0015654000OtherINDEPENCE BLUE SHIELD
PA1014077OtherGATEWAY HEALTH PLAN
PA433869OtherBLUE SHIELD
PA0015654000OtherINDEPENCE BLUE SHIELD