Provider Demographics
NPI:1427104876
Name:TRIANGLE UROLOGICAL GROUP, PC
Entity type:Organization
Organization Name:TRIANGLE UROLOGICAL GROUP, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:MAUREEN
Authorized Official - Middle Name:
Authorized Official - Last Name:KOENIG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:412-281-1757
Mailing Address - Street 1:1307 FEDERAL ST
Mailing Address - Street 2:STE 300
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15212-4769
Mailing Address - Country:US
Mailing Address - Phone:412-281-1757
Mailing Address - Fax:412-281-7274
Practice Address - Street 1:1307 FEDERAL ST
Practice Address - Street 2:STE 300
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15212-4769
Practice Address - Country:US
Practice Address - Phone:412-281-1757
Practice Address - Fax:412-281-7274
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-26
Last Update Date:2011-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CI3727OtherRR MEDICARE
PA0017421930023Medicaid
PA0017421930023Medicaid