Provider Demographics
NPI:1962458976
Name:BAKKILA, HENRY A (MD)
Entity type:Individual
Prefix:DR
First Name:HENRY
Middle Name:A
Last Name:BAKKILA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:600 WATERCREST WAY
Mailing Address - Street 2:SUITE 630
Mailing Address - City:CHESWICK
Mailing Address - State:PA
Mailing Address - Zip Code:15024-1370
Mailing Address - Country:US
Mailing Address - Phone:724-274-9451
Mailing Address - Fax:724-274-9370
Practice Address - Street 1:111 SHERIDAN ST
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15209-2639
Practice Address - Country:US
Practice Address - Phone:412-821-2277
Practice Address - Fax:412-821-1453
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2011-12-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD027136E207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0009797990001Medicaid
PA198345OtherHIGHMARK
PAC33347Medicare UPIN
PA0009797990001Medicaid