Healthcare Provider Details

I. General information

NPI: 1154575009
Provider Name (Legal Business Name): JUDITH DIVEN MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/05/2008
Last Update Date: 11/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 WASHINGTON RD STE 203
MOUNT LEBANON PA
15228-2819
US

IV. Provider business mailing address

520 WASHINGTON RD STE 203
MOUNT LEBANON PA
15228-2819
US

V. Phone/Fax

Practice location:
  • Phone: 412-563-5777
  • Fax: 412-563-0122
Mailing address:
  • Phone: 412-563-5777
  • Fax: 412-563-0122

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD018485E
License Number StatePA

VIII. Authorized Official

Name: MRS. JUDITH DIVEN
Title or Position: OWNER
Credential: MD
Phone: 412-563-5777