Provider Demographics
NPI:1053315432
Name:SALVITTI DAVIS, JENNIFER (MD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:SALVITTI DAVIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:750 E BEAU ST
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:15301-6661
Mailing Address - Country:US
Mailing Address - Phone:724-228-2982
Mailing Address - Fax:724-228-8117
Practice Address - Street 1:750 E BEAU ST
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:PA
Practice Address - Zip Code:15301-6661
Practice Address - Country:US
Practice Address - Phone:724-228-2982
Practice Address - Fax:724-228-8117
Is Sole Proprietor?:No
Enumeration Date:2005-06-13
Last Update Date:2008-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD424948207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1010855600001Medicaid
PA1626792OtherHIGHMARK
PAI06147Medicare UPIN
PA1010855600001Medicaid
PA078921Medicare ID - Type UnspecifiedMEDICARE
PA078921FJHMedicare PIN