Organization
PHYLLIS MONTELLESE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PHYLLIS MONTELLESE M.D. (PRESIDENT)
(412) 681-3200
Entity
Organization
Contact information
Practice address
128 N CRAIG ST, SUITE 216, PITTSBURGH, PA 15213-2744
(412) 681-3200
Mailing address
128 NORTH CRAIG STREET, SUITE 216, PITTSBURGH, PA 15213-4824
(412) 681-3200
Taxonomy
Speciality
Code
Description
License number
State
261QM2500X
Medical Specialty Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0010516210003
—
PA
01
—
1878693
BLUE SHIELD NUMBER
—
Enumeration date
12/04/2006
Last updated
11/28/2007
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