Healthcare Provider Details

I. General information

NPI: 1992725162
Provider Name (Legal Business Name): CARLOS A BORZUTZKY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 11/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5425 FAIR OAKS ST
PITTSBURGH PA
15217-1055
US

IV. Provider business mailing address

5425 FAIR OAKS ST
PITTSBURGH PA
15217-1055
US

V. Phone/Fax

Practice location:
  • Phone: 412-681-8879
  • Fax: 412-681-6919
Mailing address:
  • Phone: 412-681-8879
  • Fax: 412-681-6919

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberMD035047L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: