Provider Demographics
NPI:1891101929
Name:GUSTAS, KELLIE A (PA-C)
Entity Type:Individual
Prefix:
First Name:KELLIE
Middle Name:A
Last Name:GUSTAS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:200 LOTHROP ST
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15213-2536
Mailing Address - Country:US
Mailing Address - Phone:412-359-8820
Mailing Address - Fax:412-359-8822
Practice Address - Street 1:200 LOTHROP ST
Practice Address - Street 2:HVI SOUTH TOWER 3F
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15213-2536
Practice Address - Country:US
Practice Address - Phone:412-647-6000
Practice Address - Fax:412-647-2985
Is Sole Proprietor?:No
Enumeration Date:2014-07-09
Last Update Date:2022-02-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMA056903363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical