Provider Demographics
NPI:1356307987
Name:NEISH, CAROL LU (MD)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:LU
Last Name:NEISH
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 1:205 SPENCER COURT
Mailing Address - Street 2:
Mailing Address - City:MOON TOWNSHIP
Mailing Address - State:PA
Mailing Address - Zip Code:15108
Mailing Address - Country:US
Mailing Address - Phone:412-299-7948
Mailing Address - Fax:412-279-6722
Practice Address - Street 1:363 VANADIUM RD
Practice Address - Street 2:SUITE 101
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15243
Practice Address - Country:US
Practice Address - Phone:412-279-6799
Practice Address - Fax:412-279-6722
Is Sole Proprietor?:No
Enumeration Date:2006-04-22
Last Update Date:2007-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD045711L207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA734279OtherBCBS
PA208757OtherUPMC
PA208757OtherUPMC
F51715Medicare UPIN