Provider Demographics
NPI:1891953527
Name:LOGAN-DEITZ, MONCEL A (PA-C)
Entity Type:Individual
Prefix:MS
First Name:MONCEL
Middle Name:A
Last Name:LOGAN-DEITZ
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Gender:F
Credentials:PA-C
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Mailing Address - Street 1:9104 BABCOCK BLVD
Mailing Address - Street 2:SUITE 3114
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15237-5818
Mailing Address - Country:US
Mailing Address - Phone:412-367-9104
Mailing Address - Fax:412-367-8125
Practice Address - Street 1:9104 BABCOCK BLVD
Practice Address - Street 2:SUITE 3114
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15237-5818
Practice Address - Country:US
Practice Address - Phone:412-367-9104
Practice Address - Fax:412-367-8125
Is Sole Proprietor?:No
Enumeration Date:2008-05-29
Last Update Date:2017-07-11
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAMA001115L363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical