Provider Demographics
NPI:1578593547
Name:NIZZA, KENNETH A (DO)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:A
Last Name:NIZZA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:30 MEDICAL CENTER BLVD
Mailing Address - Street 2:SUITE 404
Mailing Address - City:UPLAND
Mailing Address - State:PA
Mailing Address - Zip Code:19013-3955
Mailing Address - Country:US
Mailing Address - Phone:610-619-8590
Mailing Address - Fax:610-619-8591
Practice Address - Street 1:320 E NORTH AVE
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15212-4756
Practice Address - Country:US
Practice Address - Phone:412-359-3030
Practice Address - Fax:412-359-3060
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2020-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS013670208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA5398144OtherCIGNA
PA1016821500001Medicaid
PA1892624OtherBCBS
PA30035928OtherKEYSTONE MERCY
PA7394821OtherAETNA
PA2757672000OtherBCBS
PA1351474OtherAETNA HMO
PA10168215001OtherAMERICHOICE
PA1351474OtherAETNA HMO
PA1892624OtherBCBS
I58996Medicare UPIN