Provider Demographics
NPI:1669453965
Name:BAZAZ, VITASTA (MD MPH)
Entity Type:Individual
Prefix:
First Name:VITASTA
Middle Name:
Last Name:BAZAZ
Suffix:
Gender:F
Credentials:MD MPH
Other - Prefix:
Other - First Name:VITASTA
Other - Middle Name:SENGAL
Other - Last Name:BAZAZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2100 JANE ST
Mailing Address - Street 2:STE 210
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15203-2065
Mailing Address - Country:US
Mailing Address - Phone:412-488-1880
Mailing Address - Fax:412-488-8216
Practice Address - Street 1:2100 JANE ST
Practice Address - Street 2:STE 210
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15203-2065
Practice Address - Country:US
Practice Address - Phone:412-488-1880
Practice Address - Fax:412-488-8216
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD035564-L2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA00848204Medicaid
PASE413488Medicare ID - Type Unspecified
B41397Medicare UPIN