Facts
- Status
- A
- Type
- Individual
- Enumeration date
- 2021-12-02
- Last updated
- 2026-09-23
Specialties
Licenses
- License PA
- MA063106
Location
- Practice location
- 501 BRADDOCK AVE
- City
- BRADDOCK PA
- Postal code
- 151041856
- Phone
- 412-636-5050
Medicare
- PECOS
- A PECOS enrollment row matches this NPI.
LEIE
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Nearby
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Removal request
Public data from NPPES and CMS. Not a credentialing determination.