Provider Demographics
NPI:1942272471
Name:CIVITARESE, LOUIS (DO)
Entity Type:Individual
Prefix:
First Name:LOUIS
Middle Name:
Last Name:CIVITARESE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:701 TECHNOLOGY DR STE 150
Mailing Address - Street 2:
Mailing Address - City:CANONSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15317-9531
Mailing Address - Country:US
Mailing Address - Phone:411-253-1290
Mailing Address - Fax:412-531-2948
Practice Address - Street 1:2375 GREENTREE RD
Practice Address - Street 2:
Practice Address - City:CARNEGIE
Practice Address - State:PA
Practice Address - Zip Code:15106-4203
Practice Address - Country:US
Practice Address - Phone:412-276-1560
Practice Address - Fax:412-276-5805
Is Sole Proprietor?:No
Enumeration Date:2006-02-07
Last Update Date:2023-07-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAOS006050E207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
080064080OtherRAILROAD MEDICARE PTAN
PA0014695010004Medicaid
PA0014695010003Medicaid
PA184539JFZOtherMEDICARE PTAN
PA184539JFZOtherMEDICARE PTAN