Provider Demographics
NPI:1407368947
Name:PITARO, MICHELLE KNEPPER (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:KNEPPER
Last Name:PITARO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:MICHELLE
Other - Middle Name:KATHLEEN
Other - Last Name:KNEPPER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:1000 CLIFF MINE ROAD
Mailing Address - Street 2:PARK WEST ONE, SUITE 110
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15275
Mailing Address - Country:US
Mailing Address - Phone:412-722-0102
Mailing Address - Fax:412-722-0106
Practice Address - Street 1:1000 CLIFF MINE ROAD
Practice Address - Street 2:PARK WEST ONE, SUITE 110
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15275
Practice Address - Country:US
Practice Address - Phone:412-722-0102
Practice Address - Fax:412-722-0106
Is Sole Proprietor?:No
Enumeration Date:2017-10-24
Last Update Date:2017-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA059401363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical