Healthcare Provider Details

I. General information

NPI: 1730809021
Provider Name (Legal Business Name): TRAVIS J. DEPTOLA PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2022
Last Update Date: 04/14/2026
Certification Date: 04/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

180 FORT COUCH RD STE 304
PITTSBURGH PA
15241-1041
US

IV. Provider business mailing address

180 FORT COUCH RD STE 304
PITTSBURGH PA
15241-1041
US

V. Phone/Fax

Practice location:
  • Phone: 412-831-0355
  • Fax: 412-854-5152
Mailing address:
  • Phone: 412-831-0355
  • Fax: 412-854-5152

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberMA063716
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: