Provider Demographics
NPI:1154329035
Name:HOUSE, NANCY
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:
Last Name:HOUSE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 E NORTH AVE
Mailing Address - Street 2:SUITE 500 DIVISION OF DERMATOPATHOLOGY
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15212-4756
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:419 WALNUT ST
Practice Address - Street 2:SUITE 500 DIVISION OF DERMATOPATHOLOGY
Practice Address - City:SEWICKLEY
Practice Address - State:PA
Practice Address - Zip Code:15143-1535
Practice Address - Country:US
Practice Address - Phone:412-741-9741
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-13
Last Update Date:2021-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD052227L207ND0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001922960Medicaid
PAH0767687Medicare ID - Type Unspecified
PAF79057Medicare UPIN
PA001922960Medicaid