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General NPI Number Information
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NPI Number | 1093965329
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Entity Type | Individual
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Provider Name | ELIZABETH L. DETSCHELT M.D
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Gender | Female
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Dates
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Enumeration Date | 09/23/2008
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Last Update Date | 12/26/2019
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Provider Practice Location Address
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Address Line | 530 SOUTH ST SUITE 380
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City | GREENSBURG
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State | PA
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Zip | 15601-2775
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Country | US
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Telephone | 724-261-5556
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Fax | 724-837-8984
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Provider Business Mailing Address
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Address Line | 134 INDUSTRIAL PARK RD STE 1500
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City | GREENSBURG
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State | PA
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Zip | 15601-8153
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Country | US
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Telephone | 724-850-6933
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Fax | 724-522-4002
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0204X
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Taxonomy Name | Vascular & Interventional Radiology Physician
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License Number | 259432
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 2086S0129X
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Taxonomy Name | Vascular Surgery Physician
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License Number | MD430967
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License Number State | PA
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Taxonomy #3
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 259432
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License Number State | NY
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