Provider Demographics
NPI:1003394545
Name:CARABALLO, LYANNE MARIE (PA)
Entity Type:Individual
Prefix:
First Name:LYANNE
Middle Name:MARIE
Last Name:CARABALLO
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:5200 CENTRE AVE STE 312
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15232-1302
Mailing Address - Country:US
Mailing Address - Phone:412-621-7777
Mailing Address - Fax:412-683-8698
Practice Address - Street 1:1000 INTEGRITY DR STE 110
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15235-3332
Practice Address - Country:US
Practice Address - Phone:412-342-0036
Practice Address - Fax:412-342-0041
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-06
Last Update Date:2020-10-01
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLPA9111440207RG0100X
363AM0700X
PAPA9111440363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Single Specialty
No207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty