Provider Demographics
NPI:1225021553
Name:DEITZ, DAVID R (DO)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:R
Last Name:DEITZ
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 HOT METAL ST.
Mailing Address - Street 2:QUANTUM ONE, 2ND FLOOR
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15203
Mailing Address - Country:US
Mailing Address - Phone:412-432-7400
Mailing Address - Fax:412-432-7480
Practice Address - Street 1:2 HOT METAL ST.
Practice Address - Street 2:QUANTUM ONE, 2ND FLOOR
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15203
Practice Address - Country:US
Practice Address - Phone:412-432-7400
Practice Address - Fax:412-432-7480
Is Sole Proprietor?:No
Enumeration Date:2005-08-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS006955L207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAE92600Medicare UPIN