Provider Demographics
NPI:1053459776
Name:BISSONETTE, DAVID JOHN (PA-C)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:JOHN
Last Name:BISSONETTE
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3533 RIDGEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15235-5231
Mailing Address - Country:US
Mailing Address - Phone:412-647-0965
Mailing Address - Fax:412-647-0977
Practice Address - Street 1:200 LOTHROP ST
Practice Address - Street 2:SUITE B-400 PUH, NEUROSURGERY
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15213-2536
Practice Address - Country:US
Practice Address - Phone:412-647-0965
Practice Address - Fax:412-647-0977
Is Sole Proprietor?:No
Enumeration Date:2007-02-02
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA000003L363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAMB0223975OtherDEA #
PAMB0223975OtherDEA #
PAR08362Medicare UPIN