Healthcare Provider Details

I. General information

NPI: 1942272471
Provider Name (Legal Business Name): LOUIS CIVITARESE D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2006
Last Update Date: 07/06/2023
Certification Date: 07/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2375 GREENTREE RD
CARNEGIE PA
15106-4203
US

IV. Provider business mailing address

701 TECHNOLOGY DR STE 150
CANONSBURG PA
15317-9531
US

V. Phone/Fax

Practice location:
  • Phone: 412-276-1560
  • Fax: 412-276-5805
Mailing address:
  • Phone: 411-253-1290
  • Fax: 412-531-2948

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS006050E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: