Provider Demographics
NPI:1720165509
Name:ABEBE, ALYSSA B (PA-C)
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:B
Last Name:ABEBE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5820 CENTRE AVE
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15206-3710
Mailing Address - Country:US
Mailing Address - Phone:412-661-5500
Mailing Address - Fax:412-661-4760
Practice Address - Street 1:5820 CENTRE AVE
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15206-3710
Practice Address - Country:US
Practice Address - Phone:412-661-5500
Practice Address - Fax:412-661-4760
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2008-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA052705363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
1074070OtherNCCPA
PAMA052705OtherMEDICAL LICENSE
PAMA052705OtherMEDICAL LICENSE