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General NPI Number Information
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NPI Number | 1669453965
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Entity Type | Individual
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Provider Name | VITASTA BAZAZ MD MPH
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Gender | Female
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Dates
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Enumeration Date | 11/14/2005
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 2100 JANE ST STE 210
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City | PITTSBURGH
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State | PA
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Zip | 15203-2065
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Country | US
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Telephone | 412-488-1880
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Fax | 412-488-8216
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Provider Business Mailing Address
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Address Line | 2100 JANE ST STE 210
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City | PITTSBURGH
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State | PA
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Zip | 15203-2065
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Country | US
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Telephone | 412-488-1880
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Fax | 412-488-8216
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | MD035564-L
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License Number State | PA
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