Provider Demographics
NPI:1487962528
Name:PEDIATRIC ALLIANCE, P.C CHARTIERS DIVISION
Entity type:Organization
Organization Name:PEDIATRIC ALLIANCE, P.C CHARTIERS DIVISION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF CLINICAL OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:CERRA
Authorized Official - Suffix:I
Authorized Official - Credentials:RN, BSN
Authorized Official - Phone:412-278-5100
Mailing Address - Street 1:1100 WASHINGTON AVE
Mailing Address - Street 2:SUITE 210
Mailing Address - City:CARNEGIE
Mailing Address - State:PA
Mailing Address - Zip Code:15106-3614
Mailing Address - Country:US
Mailing Address - Phone:412-278-5100
Mailing Address - Fax:412-278-5105
Practice Address - Street 1:1370 WASHINGTON PIKE
Practice Address - Street 2:SUITE 107
Practice Address - City:BRIDGEVILLE
Practice Address - State:PA
Practice Address - Zip Code:15017-2862
Practice Address - Country:US
Practice Address - Phone:412-221-0160
Practice Address - Fax:412-221-0858
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PEDIATRIC ALLIANCE, P.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-09-23
Last Update Date:2010-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD061104L208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty