| Classic Care Gerontology | |
|
815 Freeport Rd 100 Med Arts Bldg Suite 105 Pittsburgh PA 15215-3301 | |
| (412) 647-0943 | |
| (412) 647-4050 |
| Full Name | Classic Care Gerontology |
|---|---|
| Speciality | Internal Medicine |
| Location | 815 Freeport Rd, Pittsburgh, Pennsylvania |
| Authorized Official Name and Position | Mark Ehalt (DIRECTOR, REVENUE CYCLE) |
| Authorized Official Contact | 4126470943 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Classic Care Gerontology 815 Freeport Rd 100 Med Arts Bldg Suite 105 Pittsburgh PA 15215-3301 Ph: (412) 647-0943 | Classic Care Gerontology 815 Freeport Rd 100 Med Arts Bldg Suite 105 Pittsburgh PA 15215-3301 Ph: (412) 647-0943 |
| NPI Number | 1225088313 |
|---|---|
| Provider Enumeration Date | 05/11/2006 |
| Last Update Date | 10/26/2007 |
| Medicare PECOS PAC ID | 8022912187 |
|---|---|
| Medicare Enrollment ID | O20040225000011 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1225088313 | NPI | - | NPPES |
| HIGHMARK PSYCH MANAG | Other | PA | 272784 |
| HIGHMARK BC/BS | Other | PA | 1443485 |
| HIGHMARK PSYCH | Other | PA | 1661252 |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TA0700X | Psychologist - Adult Development & Aging | (* (Not Available)) | Secondary |
| 207RG0300X | Internal Medicine - Geriatric Medicine | (* (Not Available)) | Primary |
| Provider Name | Erin L Imler |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1649455841 PECOS PAC ID: 7517155948 Enrollment ID: I20101229000120 |
| Provider Name | Amy J Diplacido |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1235314428 PECOS PAC ID: 8729262209 Enrollment ID: I20110407000117 |
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