Provider Demographics
NPI:1598769465
Name:PINCAVITCH, JAMI DIAMOND (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMI
Middle Name:DIAMOND
Last Name:PINCAVITCH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JAMI
Other - Middle Name:DIAMOND
Other - Last Name:BORIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:350 BONAR AVENUE
Mailing Address - Street 2:
Mailing Address - City:WAYNESBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15370
Mailing Address - Country:US
Mailing Address - Phone:724-627-3101
Mailing Address - Fax:724-627-7639
Practice Address - Street 1:350 BONAR AVENUE
Practice Address - Street 2:
Practice Address - City:WAYNESBURG
Practice Address - State:PA
Practice Address - Zip Code:15370
Practice Address - Country:US
Practice Address - Phone:724-627-3101
Practice Address - Fax:724-627-7639
Is Sole Proprietor?:No
Enumeration Date:2005-06-09
Last Update Date:2021-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD418743208000000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA10923424OtherAETNA
PA136496OtherTHREE RIVERS
PA1393136OtherBCBS
PA0019036320001Medicaid
PA312927OtherUPMC
PAP004715OtherGATEWAY
PA10923424OtherAETNA
PA1393136OtherBCBS
PA060713QWKMedicare PIN