Provider Demographics
NPI:1255564910
Name:DATTILO, COLLEEN MCDONNELL (MD)
Entity type:Individual
Prefix:DR
First Name:COLLEEN
Middle Name:MCDONNELL
Last Name:DATTILO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:COLLEEN
Other - Middle Name:
Other - Last Name:MCDONNELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:625 RIDGEVIEW DR
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15228-1705
Mailing Address - Country:US
Mailing Address - Phone:412-343-7629
Mailing Address - Fax:
Practice Address - Street 1:625 RIDGEVIEW DR
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15228-1705
Practice Address - Country:US
Practice Address - Phone:412-343-7629
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-28
Last Update Date:2009-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD024017E208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics