Provider Demographics
NPI:1427021674
Name:DERIENZO, UMBERTO ANTHONY (MD)
Entity Type:Individual
Prefix:
First Name:UMBERTO
Middle Name:ANTHONY
Last Name:DERIENZO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 TECHNOLOGY DR STE 150
Mailing Address - Street 2:
Mailing Address - City:CANONSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15317-9531
Mailing Address - Country:US
Mailing Address - Phone:412-531-2902
Mailing Address - Fax:412-531-2948
Practice Address - Street 1:17 ARENTZEN BLVD
Practice Address - Street 2:
Practice Address - City:CHARLEROI
Practice Address - State:PA
Practice Address - Zip Code:15022-1085
Practice Address - Country:US
Practice Address - Phone:724-483-3581
Practice Address - Fax:724-483-3483
Is Sole Proprietor?:No
Enumeration Date:2006-02-08
Last Update Date:2023-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD053835L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0015317510003Medicaid
PA0015317510003Medicaid
PAG10035Medicare UPIN