Healthcare Provider Details

I. General information

NPI: 1265432298
Provider Name (Legal Business Name): ALLAN HENRY TISSENBAUM MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2005
Last Update Date: 11/02/2021
Certification Date: 11/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 PLAZA DRIVE SUITE 400
BELLE VERNON PA
15012
US

IV. Provider business mailing address

800 PLAZA DR STE 400
ROSTRAVER TWP PA
15012-4019
US

V. Phone/Fax

Practice location:
  • Phone: 724-379-5816
  • Fax: 724-379-5874
Mailing address:
  • Phone: 724-379-5802
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberMD051744L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: