Provider Demographics
NPI:1295181048
Name:PEZZONE GASTROENTEROLOGY ASSOCIATES
Entity Type:Organization
Organization Name:PEZZONE GASTROENTEROLOGY ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:PEZZONE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:724-503-4637
Mailing Address - Street 1:86 WELLNESS WAY
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:15301-9720
Mailing Address - Country:US
Mailing Address - Phone:724-503-4637
Mailing Address - Fax:724-503-4429
Practice Address - Street 1:86 WELLNESS WAY
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:PA
Practice Address - Zip Code:15301-9720
Practice Address - Country:US
Practice Address - Phone:724-503-4637
Practice Address - Fax:724-503-4429
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-11
Last Update Date:2016-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA057989363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Single Specialty