Provider Demographics
NPI:1245232115
Name:ZUCKERMAN, MYLES H (MD)
Entity Type:Individual
Prefix:DR
First Name:MYLES
Middle Name:H
Last Name:ZUCKERMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:50 MOFFETT ST
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15243-1162
Mailing Address - Country:US
Mailing Address - Phone:412-572-8823
Mailing Address - Fax:412-572-8755
Practice Address - Street 1:2500 BALDWICK RD
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15205-4140
Practice Address - Country:US
Practice Address - Phone:412-922-6262
Practice Address - Fax:412-922-5026
Is Sole Proprietor?:No
Enumeration Date:2005-08-11
Last Update Date:2015-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD033411-E207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1001174Medicaid
PA1001174Medicaid
PAD71140Medicare UPIN