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Organization
TRI-STATE MEDICAL GROUP, INC
Active
Organization
TRI-STATE MEDICAL GROUP, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NORMAN F MITRY (PRESIDENT & CEO)
(724) 773-4776
Entity
Organization
Contact information
Practice address
1185 FREEDOM RD, SUITE B106, CRANBERRY TWP, PA 16066-4913
(724) 777-3596
Mailing address
1185 FREEDOM RD, SUITE B106, CRANBERRY TWP, PA 16066-4913
(724) 773-5964
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0015654460023
—
PA
05
—
0202677
—
OH
Enumeration date
07/09/2009
Last updated
07/09/2009
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