=====================================================
General NPI Number Information
=====================================================
NPI Number | 1013979541
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MITZI K. HEMSTREET MD, PHD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/03/2006
-----------------------------------------------------
Last Update Date | 12/31/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7777 STEUBENVILLE PIKE
-----------------------------------------------------
City | OAKDALE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15071-3409
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 412-867-9759
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1160 INGOMAR HEIGHTS RD
-----------------------------------------------------
City | PITTSBURGH
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15237-4263
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 412-867-9759
-----------------------------------------------------
Fax | 412-367-5855
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207L00000X
-----------------------------------------------------
Taxonomy Name | Anesthesiology Physician
-----------------------------------------------------
License Number | 22559
-----------------------------------------------------
License Number State | WV
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207L00000X
-----------------------------------------------------
Taxonomy Name | Anesthesiology Physician
-----------------------------------------------------
License Number | MD420691
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------