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Organization
PRIMARY CARE GROUP 12, INC.,
Active
Organization
PRIMARY CARE GROUP 12, INC.,
Active
Parent organization
JEFFERSON REGIONAL MEDICAL CENTER
Other names
DeRienzo Family Practice
Organization subpart
Yes
Provider details
NPI number
Legal business name
JEFFERSON REGIONAL MEDICAL CENTER
Authorized official
UMBERTO A. DERIENZO M.D. (PRESIDENT)
(724) 483-3581
Entity
Organization
Contact information
Practice address
17 ARENTZEN BLVD, SUITE 101, CHARLEROI, PA 15022-1085
(724) 483-3581
(724) 483-3483
Mailing address
17 ARENTZEN BLVD, SUITE 101, CHARLEROI, PA 15022-1085
(724) 483-3581
(724) 483-3483
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD053835L
PA
Other
Enumeration date
09/29/2010
Last updated
03/21/2011
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