Healthcare Provider Details

I. General information

NPI: 1073700233
Provider Name (Legal Business Name): DANIELLE M LOUTH PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/01/2007
Last Update Date: 10/08/2020
Certification Date: 10/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4727 FRIENDSHIP AVE STE 340
PITTSBURGH PA
15224-1778
US

IV. Provider business mailing address

4727 FRIENDSHIP AVE STE 340
PITTSBURGH PA
15224-1778
US

V. Phone/Fax

Practice location:
  • Phone: 412-235-5830
  • Fax: 412-235-5833
Mailing address:
  • Phone: 412-235-5830
  • Fax: 412-235-5833

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberMA053885
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: