Provider Demographics
NPI:1568798957
Name:C.CHARLES IANNUZZI,M.D.,PC
Entity Type:Organization
Organization Name:C.CHARLES IANNUZZI,M.D.,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:C.
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:IANNUZZI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:412-531-5759
Mailing Address - Street 1:764 SCRUBGRASS RD
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15243-1124
Mailing Address - Country:US
Mailing Address - Phone:412-531-5759
Mailing Address - Fax:412-571-1516
Practice Address - Street 1:2115 NOBLE ST
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15218-2513
Practice Address - Country:US
Practice Address - Phone:412-351-5313
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-20
Last Update Date:2009-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA000651568 0002Medicaid
PA015312Medicare PIN
PA011863918Medicare PIN