Provider Demographics
NPI:1821099573
Name:LEBOVITZ, PAUL JAY (MD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:JAY
Last Name:LEBOVITZ
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 1:1307 FEDERAL ST STE B100
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15212-4761
Mailing Address - Country:US
Mailing Address - Phone:412-359-8900
Mailing Address - Fax:412-359-8977
Practice Address - Street 1:1307 FEDERAL ST STE B100
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15212-4761
Practice Address - Country:US
Practice Address - Phone:412-359-8900
Practice Address - Fax:412-359-8977
Is Sole Proprietor?:No
Enumeration Date:2005-08-03
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD042469E207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
10930811OtherCAQH
PA001166521Medicaid
PA001166521Medicaid
PA001166521Medicaid
PACG2169Medicare PIN
PA0011665210014Medicaid
PA100013345Medicare PIN
OH0994223Medicaid
WV0088385Medicaid
PA0011665210013Medicaid
PACG2279Medicare PIN
PA100013347Medicare PIN
PAF82140Medicare UPIN
PACG2282Medicare PIN