Provider Demographics
NPI:1740647072
Name:DWYER, JESSICA BURNEY (MD)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:BURNEY
Last Name:DWYER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:GRAY
Other - Last Name:BURNEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:20 LOVE PL
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15218-1444
Mailing Address - Country:US
Mailing Address - Phone:412-371-3859
Mailing Address - Fax:
Practice Address - Street 1:1520 PENN AVE
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15222-4313
Practice Address - Country:US
Practice Address - Phone:412-350-4800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-17
Last Update Date:2016-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD453315207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology