Provider Demographics
NPI:1922730647
Name:ALSTON, DAVAUGHN
Entity Type:Individual
Prefix:
First Name:DAVAUGHN
Middle Name:
Last Name:ALSTON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 CLINTON ST
Mailing Address - Street 2:
Mailing Address - City:MC KEES ROCKS
Mailing Address - State:PA
Mailing Address - Zip Code:15136-1919
Mailing Address - Country:US
Mailing Address - Phone:412-883-1326
Mailing Address - Fax:
Practice Address - Street 1:239 4TH AVE STE 1401
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15222-1715
Practice Address - Country:US
Practice Address - Phone:866-992-2538
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-30
Last Update Date:2022-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA629836013747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1040111300001Medicaid