Individual
AMANDA SAMPLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
300 HALKET ST STE 5730, PITTSBURGH, PA 15213-3108
(412) 621-7575
(412) 621-6353
Mailing address
2990 MACK RD, STE 110, FAIRFIELD, OH 45014-5383
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
MD472216
PA
390200000X
Student in an Organized Health Care Education/Training Program
MD472216
PA
Other
Enumeration date
07/14/2009
Last updated
06/09/2021
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