Provider Demographics
NPI:1184829533
Name:ZISS, BETHANY ELLEN (MD)
Entity Type:Individual
Prefix:
First Name:BETHANY
Middle Name:ELLEN
Last Name:ZISS
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 1:1405 SHADY AVE
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15217-1350
Mailing Address - Country:US
Mailing Address - Phone:412-420-2561
Mailing Address - Fax:412-420-2595
Practice Address - Street 1:4815 LIBERTY AVE STE 154
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15224-2156
Practice Address - Country:US
Practice Address - Phone:412-578-4003
Practice Address - Fax:412-578-4011
Is Sole Proprietor?:No
Enumeration Date:2007-06-17
Last Update Date:2019-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD454191208000000X, 2080P0006X
SC334732080P0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0006XAllopathic & Osteopathic PhysiciansPediatricsDevelopmental - Behavioral Pediatrics
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1030053080001Medicaid
SCPENDINGMedicaid
SCPENDINGMedicare PIN
PA404576PWZMedicare PIN