Healthcare Provider Details

I. General information

NPI: 1306475363
Provider Name (Legal Business Name): DAVID GUSTAFSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/02/2020
Last Update Date: 03/22/2026
Certification Date: 03/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

875 GREENTREE RD STE 325
PITTSBURGH PA
15220-3508
US

IV. Provider business mailing address

875 GREENTREE RD STE 325
PITTSBURGH PA
15220-3508
US

V. Phone/Fax

Practice location:
  • Phone: 412-920-7994
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number35.149829
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code207ZD0900X
TaxonomyDermatopathology (Pathology) Physician
License NumberMD489263C
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: