Provider Demographics
NPI:1972669117
Name:CORDISCO, DAVID JOHN (PHD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:JOHN
Last Name:CORDISCO
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1376 FREEPORT RD
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15238-3110
Mailing Address - Country:US
Mailing Address - Phone:412-963-7744
Mailing Address - Fax:412-486-5059
Practice Address - Street 1:1376 FREEPORT RD
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15238-3110
Practice Address - Country:US
Practice Address - Phone:412-963-7744
Practice Address - Fax:412-486-5059
Is Sole Proprietor?:No
Enumeration Date:2006-12-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS003622L103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR160024OtherHIGHMARK