Healthcare Provider Details

I. General information

NPI: 1093090268
Provider Name (Legal Business Name): MICHAEL TALOTTA PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2011
Last Update Date: 10/05/2020
Certification Date: 10/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4815 LIBERTY AVE STE 154
PITTSBURGH PA
15224-2156
US

IV. Provider business mailing address

4815 LIBERTY AVE STE 154
PITTSBURGH PA
15224-2156
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberMA055254
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: