Provider Demographics
NPI:1285761064
Name:UPMC COMMUNITY MEDICINE INC
Entity type:Organization
Organization Name:UPMC COMMUNITY MEDICINE INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:EHALT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:412-647-0943
Mailing Address - Street 1:1600 WILDLIFE LODGE RD
Mailing Address - Street 2:SUITE 300 BURRELL MEDICAL CENTER
Mailing Address - City:LOWER BURRELL
Mailing Address - State:PA
Mailing Address - Zip Code:15068-3641
Mailing Address - Country:US
Mailing Address - Phone:724-226-1400
Mailing Address - Fax:
Practice Address - Street 1:1600 WILDLIFE LODGE RD
Practice Address - Street 2:SUITE 300 BURRELL MEDICAL CENTER
Practice Address - City:LOWER BURRELL
Practice Address - State:PA
Practice Address - Zip Code:15068-3641
Practice Address - Country:US
Practice Address - Phone:724-226-1400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-27
Last Update Date:2007-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA042490Medicare ID - Type Unspecified
PA042490Medicare PIN