Healthcare Provider Details

I. General information

NPI: 1700824943
Provider Name (Legal Business Name): FERAS TAWFIQ AL-ISSA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2006
Last Update Date: 02/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 LOTHROP ST FORBES TOWER SUITE 9055
PITTSBURGH PA
15213-2546
US

IV. Provider business mailing address

200 LOTHROP ST
PITTSBURGH PA
15213-2536
US

V. Phone/Fax

Practice location:
  • Phone: 412-647-3087
  • Fax: 412-647-4486
Mailing address:
  • Phone: 412-692-5180
  • Fax: 412-692-7355

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0206X
TaxonomyPediatric Gastroenterology Physician
License NumberMD425504
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: