Organization
MITRE GASTROENTEROLOGY ASSOCIATES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RICARDO MITRE M.D. (MEDICAL DIRECTOR)
(412) 321-1648
Entity
Organization
Contact information
Practice address
925 BRIGHTON RD, PITTSBURGH, PA 15233-1707
(412) 321-1648
(412) 321-4216
Mailing address
925 BRIGHTON RD, PITTSBURGH, PA 15233-1707
(412) 321-1648
(412) 321-4216
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
MD032806L
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1009520810001
—
NJ
01
—
1568734
BLUE CROSS BLUE SHIELD
NJ
Enumeration date
06/19/2006
Last updated
08/22/2020
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