MEDICARE: CHARLOTTE MATTOX HOLT RAYBURN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1386347490
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARLOTTE MATTOX HOLT RAYBURN M.D.

Provider Business Mailing Address
First Line	:	3600 FORBES AVE STE 140
Second Line	:
City	:	PITTSBURGH
State	:	PA
Zip	:	15213-3410
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3417 5TH AVE BLDG 4TH
Second Line	:
City	:	PITTSBURGH
State	:	PA
Zip	:	15213-3204
Country	:	US
Telephone Number	:	412-692-4540
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/27/2023
Last Update Date	:	03/27/2023

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