Provider Demographics
NPI:1720058761
Name:BOETTCHER, ANNA MARIE (MD)
Entity Type:Individual
Prefix:DR
First Name:ANNA
Middle Name:MARIE
Last Name:BOETTCHER
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 1:1200 REEDSDALE ST
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15233-2109
Mailing Address - Country:US
Mailing Address - Phone:412-323-4519
Mailing Address - Fax:412-323-4507
Practice Address - Street 1:412 E COMMONS
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15212-5310
Practice Address - Country:US
Practice Address - Phone:412-323-4519
Practice Address - Fax:412-323-4507
Is Sole Proprietor?:No
Enumeration Date:2006-01-24
Last Update Date:2010-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC271282084P0800X
PAMD 063328L2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01770984Medicaid
PA031647KJ7OtherPIN
PAH04509Medicare UPIN