Healthcare Provider Details

I. General information

NPI: 1720050289
Provider Name (Legal Business Name): DERIENZO FAMILY PRACTICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17 ARENTZEN BLVD
CHARLEROI PA
15022-1085
US

IV. Provider business mailing address

17 ARENTZEN BLVD
CHARLEROI PA
15022-1085
US

V. Phone/Fax

Practice location:
  • Phone: 724-483-3581
  • Fax: 724-483-3483
Mailing address:
  • Phone: 724-483-3581
  • Fax: 724-483-3483

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: UMBERTO ANTHONY DERIENZO
Title or Position: OWNER
Credential: MD
Phone: 724-483-3581