Healthcare Provider Details

I. General information

NPI: 1205835691
Provider Name (Legal Business Name): KIMBERLY M PEZZONE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2005
Last Update Date: 01/04/2022
Certification Date: 01/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 MARKET PLACE DR
OAKDALE PA
15071-4007
US

IV. Provider business mailing address

651 COLLIERS WAY STE 300
WEIRTON WV
26062-5058
US

V. Phone/Fax

Practice location:
  • Phone: 724-281-1931
  • Fax: 724-218-1934
Mailing address:
  • Phone: 304-797-6404
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD051032L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: