Provider Demographics
NPI:1922009901
Name:ITSKOWITZ, MARC SAMUEL (MD)
Entity Type:Individual
Prefix:
First Name:MARC
Middle Name:SAMUEL
Last Name:ITSKOWITZ
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 304
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15212-4769
Mailing Address - Country:US
Mailing Address - Phone:412-359-3682
Mailing Address - Fax:412-359-8541
Practice Address - Street 1:1307 FEDERAL ST STE 304
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15212-4769
Practice Address - Country:US
Practice Address - Phone:412-359-3682
Practice Address - Fax:412-359-8541
Is Sole Proprietor?:No
Enumeration Date:2005-08-02
Last Update Date:2020-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD0728972207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2680380Medicaid
WV3810002460Medicaid
PA001852936Medicaid
PAH40826Medicare UPIN
WV3810002460Medicaid
PA049026NJEMedicare PIN
OH2680380Medicaid