Provider Demographics
NPI:1538120977
Name:VERSTRAETEN, THIERRY C (MD)
Entity Type:Individual
Prefix:
First Name:THIERRY
Middle Name:C
Last Name:VERSTRAETEN
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 1:420 EAST NORTH AVE
Mailing Address - Street 2:STE 116
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15212
Mailing Address - Country:US
Mailing Address - Phone:412-359-6300
Mailing Address - Fax:412-359-6768
Practice Address - Street 1:420 EAST NORTH AVE
Practice Address - Street 2:STE 116
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15212
Practice Address - Country:US
Practice Address - Phone:412-359-6300
Practice Address - Fax:412-359-6768
Is Sole Proprietor?:No
Enumeration Date:2006-03-28
Last Update Date:2015-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD040713L207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0013027680004Medicaid
122785J4EMedicare ID - Type Unspecified
PA0013027680004Medicaid