Provider Demographics
NPI:1225524978
Name:ALIE-CUSSON, FANNY (MD)
Entity Type:Individual
Prefix:DR
First Name:FANNY
Middle Name:
Last Name:ALIE-CUSSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:FANNY
Other - Middle Name:SARAH
Other - Last Name:ALIE-CUSSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:200 LOTHROP ST
Mailing Address - Street 2:E351.1 SOUTH TOWER PUH
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15213-2536
Mailing Address - Country:US
Mailing Address - Phone:412-802-3333
Mailing Address - Fax:
Practice Address - Street 1:1350 LOCUST STREET
Practice Address - Street 2:BUILDING C, SUITE G-100
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15219
Practice Address - Country:US
Practice Address - Phone:412-232-9030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-05
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2023-022602086S0129X
PAMD4712372086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery