Individual
GRACE FORT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4401 PENN AVE, PITTSBURGH, PA 15224-1342
(412) 692-5325
Mailing address
203 SUMMIT ACRES DR, MARS, PA 16046-1400
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
MA066415
PA
Other
Enumeration date
03/03/2025
Last updated
03/05/2025
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