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General NPI Number Information
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NPI Number | 1295181048
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Entity Type | Organization
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Legal Business Name | PEZZONE GASTROENTEROLOGY ASSOCIATES
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Dates
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Enumeration Date | 05/11/2016
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Last Update Date | 05/11/2016
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Provider Practice Location Address
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Address Line | 86 WELLNESS WAY
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City | WASHINGTON
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State | PA
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Zip | 15301-9720
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Country | US
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Telephone | 724-503-4637
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Fax | 724-503-4429
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Provider Business Mailing Address
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Address Line | 86 WELLNESS WAY
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City | WASHINGTON
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State | PA
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Zip | 15301-9720
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Country | US
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Telephone | 724-503-4637
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Fax | 724-503-4429
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. MICHAEL PEZZONE
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Credential | M.D.
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Telephone | 724-503-4637
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | MA057989
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License Number State | PA
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