| NPI | 1174959175 |
|---|---|
| Former Legal Business Name | WATERDAM FAMILY PRACTICE |
| Entity Type | Organization |
| Authorized Contact | DENISE NOEL Director Provider Enrollment 412-330-5861 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Enumeration Date | 2013-09-23 |
| Last Update Date | 2020-11-06 |