Provider Demographics
NPI:1164485694
Name:PEDUZZI, TRINA L (MD)
Entity Type:Individual
Prefix:
First Name:TRINA
Middle Name:L
Last Name:PEDUZZI
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 1:1100 WASHINGTON AVE STE 215
Mailing Address - Street 2:
Mailing Address - City:CARNEGIE
Mailing Address - State:PA
Mailing Address - Zip Code:15106-3616
Mailing Address - Country:US
Mailing Address - Phone:412-596-8408
Mailing Address - Fax:412-278-5105
Practice Address - Street 1:490 E NORTH AVE STE 207
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15212-4740
Practice Address - Country:US
Practice Address - Phone:412-930-0908
Practice Address - Fax:412-930-0925
Is Sole Proprietor?:No
Enumeration Date:2006-04-07
Last Update Date:2017-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD072601L208000000X
NY221180208000000X, 2080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102025960Medicaid
NY02206022Medicaid