Provider Demographics
NPI:1215923164
Name:WHITEFORD, JOHN
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:WHITEFORD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1501 LOCUST ST
Mailing Address - Street 2:SUITE 403
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15219-5136
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1400 LOCUST ST
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15219-5114
Practice Address - Country:US
Practice Address - Phone:412-232-8222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-26
Last Update Date:2021-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD420520207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA000000142773OtherUNISON
PA1530411OtherGATEWAY
PA6728612OtherCIGNA
PA7276426OtherAETNA PIN
PA0019481060005Medicaid
PA315361OtherUPMC
PA1452799OtherBCBS PA
OH2553222OtherOHIO MEDICAID
PA3328194OtherAETNA PVN
PAP00012629OtherRR MEDICARE
PAP00012629OtherRR MEDICARE
PA067734JK6Medicare ID - Type Unspecified