Provider Demographics
NPI:1528066180
Name:ADELSHEIMER, MARC JEFFREY (MD)
Entity type:Individual
Prefix:
First Name:MARC
Middle Name:JEFFREY
Last Name:ADELSHEIMER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5444 ALBEMARLE AVE
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15217-1133
Mailing Address - Country:US
Mailing Address - Phone:412-681-1638
Mailing Address - Fax:412-683-6386
Practice Address - Street 1:107 GAMMA DR
Practice Address - Street 2:SUITE 200
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15238-2917
Practice Address - Country:US
Practice Address - Phone:412-963-6480
Practice Address - Fax:412-963-6820
Is Sole Proprietor?:No
Enumeration Date:2005-07-08
Last Update Date:2016-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD059198L174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001594377 0010Medicaid
PAG00975Medicare UPIN
PA001594377 0010Medicaid