Healthcare Provider Details

I. General information

NPI: 1184829533
Provider Name (Legal Business Name): BETHANY ELLEN ZISS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2007
Last Update Date: 10/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4815 LIBERTY AVE STE 154
PITTSBURGH PA
15224-2156
US

IV. Provider business mailing address

1405 SHADY AVE
PITTSBURGH PA
15217-1350
US

V. Phone/Fax

Practice location:
  • Phone: 412-578-4003
  • Fax: 412-578-4011
Mailing address:
  • Phone: 412-420-2561
  • Fax: 412-420-2595

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD454191
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code2080P0006X
TaxonomyDevelopmental - Behavioral Pediatrics Physician
License Number33473
License Number StateSC
# 3
Primary TaxonomyY
Taxonomy Code2080P0006X
TaxonomyDevelopmental - Behavioral Pediatrics Physician
License NumberMD454191
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: