Healthcare Provider Details

I. General information

NPI: 1699776633
Provider Name (Legal Business Name): DIANE INSERRA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2005
Last Update Date: 12/11/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

651 HOLIDAY DR SUITE 1500
PITTSBURGH PA
15220-2740
US

IV. Provider business mailing address

651 HOLIDAY DR SUITE 1500
PITTSBURGH PA
15220-2740
US

V. Phone/Fax

Practice location:
  • Phone: 412-920-5615
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberMD046260L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: