Organization
BANKSVILLE MEDICAL, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHARLES F DIEDERICH I M.D. (PRESIDENT)
(412) 341-6650
Entity
Organization
Contact information
Practice address
2508 BANKSVILLE AVE, PITTSBURGH, PA 15216-2802
(412) 341-6650
Mailing address
2508 BANKSVILLE AVE, PITTSBURGH, PA 15216-2802
(412) 341-6650
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0015084300003
—
PA
01
—
1979748
HIGHMARK BC/BS
PA
Enumeration date
08/09/2007
Last updated
10/11/2007
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