Provider Demographics
NPI:1356399034
Name:DIVENANZO, DEBBIE A (MD)
Entity type:Individual
Prefix:
First Name:DEBBIE
Middle Name:A
Last Name:DIVENANZO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1524 HIGH RD
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON HILLS
Mailing Address - State:PA
Mailing Address - Zip Code:15025-3524
Mailing Address - Country:US
Mailing Address - Phone:412-384-7964
Mailing Address - Fax:
Practice Address - Street 1:500 LEWIS RUN RD
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15122-3056
Practice Address - Country:US
Practice Address - Phone:412-469-6964
Practice Address - Fax:412-469-6948
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2007-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD048661L207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA007831M5SMedicare ID - Type UnspecifiedPROVIDER NUMBER