Provider Demographics
NPI:1508826298
Name:MIDDLETON, JODY L (PAC)
Entity Type:Individual
Prefix:
First Name:JODY
Middle Name:L
Last Name:MIDDLETON
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5900 CORPORATE DRIVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15237
Mailing Address - Country:US
Mailing Address - Phone:412-369-4000
Mailing Address - Fax:412-369-7667
Practice Address - Street 1:5900 CORPORATE DRIVE
Practice Address - Street 2:SUITE 200
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15237
Practice Address - Country:US
Practice Address - Phone:412-369-4000
Practice Address - Fax:412-369-7667
Is Sole Proprietor?:No
Enumeration Date:2006-03-25
Last Update Date:2009-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA051697363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA50048233Other50048233
PA1161847OtherAETNA
PA253313OtherHEALTHAMERICA/HEALTHASSUR
PA148423FYLMedicare PIN
PA1161847OtherAETNA