Healthcare Provider Details

I. General information

NPI: 1508399403
Provider Name (Legal Business Name): ALYSSA FAZI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2017
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3471 5TH AVE STE 402
PITTSBURGH PA
15213-3221
US

IV. Provider business mailing address

PO BOX 780
MORGANTOWN WV
26507-0780
US

V. Phone/Fax

Practice location:
  • Phone: 412-692-4528
  • Fax: 304-598-4930
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number29126
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: