Healthcare Provider Details

I. General information

NPI: 1073515441
Provider Name (Legal Business Name): TIFFANY PLUTO D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/15/2005
Last Update Date: 04/21/2022
Certification Date: 04/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 CROSSROADS RD SUITE 201
SCOTTDALE PA
15683-2417
US

IV. Provider business mailing address

506 ATHENA DR
DELMONT PA
15626-1005
US

V. Phone/Fax

Practice location:
  • Phone: 724-887-5989
  • Fax: 724-887-0129
Mailing address:
  • Phone: 724-468-6869
  • Fax: 724-468-6207

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS010516L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: