Provider Demographics
NPI:1528510336
Name:UPMC COMMUNITY MEDICINE INC
Entity type:Organization
Organization Name:UPMC COMMUNITY MEDICINE INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SR. MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:CALDWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:412-432-5846
Mailing Address - Street 1:304 EVANS DR
Mailing Address - Street 2:SUITE 201
Mailing Address - City:ELLWOOD CITY
Mailing Address - State:PA
Mailing Address - Zip Code:16117-1477
Mailing Address - Country:US
Mailing Address - Phone:724-752-8722
Mailing Address - Fax:724-752-5508
Practice Address - Street 1:304 EVANS DR
Practice Address - Street 2:SUITE 201
Practice Address - City:ELLWOOD CITY
Practice Address - State:PA
Practice Address - Zip Code:16117-1477
Practice Address - Country:US
Practice Address - Phone:724-752-8722
Practice Address - Fax:724-752-5508
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-27
Last Update Date:2016-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
042490OtherMC GROUP PTAN