Healthcare Provider Details

I. General information

NPI: 1811563109
Provider Name (Legal Business Name): ALEC JAMES DIVITO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/27/2021
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date: 06/16/2022
Reactivation Date: 07/14/2022

III. Provider practice location address

101 FREEPORT RD
ASPINWALL PA
15215-2943
US

IV. Provider business mailing address

101 FREEPORT RD
ASPINWALL PA
15215-2943
US

V. Phone/Fax

Practice location:
  • Phone: 412-444-8636
  • Fax: 844-688-8724
Mailing address:
  • Phone: 412-444-8636
  • Fax: 844-688-8724

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD484982
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: