Provider Demographics
NPI:1073515441
Name:PLUTO, TIFFANY (DO)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:
Last Name:PLUTO
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:506 ATHENA DR
Mailing Address - Street 2:
Mailing Address - City:DELMONT
Mailing Address - State:PA
Mailing Address - Zip Code:15626-1005
Mailing Address - Country:US
Mailing Address - Phone:724-468-6869
Mailing Address - Fax:724-468-6207
Practice Address - Street 1:109 CROSSROADS RD
Practice Address - Street 2:SUITE 201
Practice Address - City:SCOTTDALE
Practice Address - State:PA
Practice Address - Zip Code:15683-2417
Practice Address - Country:US
Practice Address - Phone:724-887-5989
Practice Address - Fax:724-887-0129
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-15
Last Update Date:2022-04-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAOS010516L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0018717080004Medicaid
028371PZOMedicare ID - Type Unspecified
PAG96638Medicare UPIN