MEDICARE: DR. JACOB CONVISSAR DO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1154959971
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JACOB CONVISSAR DO

Provider Business Mailing Address
First Line	:	3600 FORBES AVE
Second Line	:	FORBES TOWER- PLAZA LEVEL SUITE 140
City	:	PITTSBURGH
State	:	PA
Zip	:	15213-3410
Country	:	US
Telephone Number	:	724-281-3297
Fax Number	:

Provider Business Practice Location Address
First Line	:	4401 PENN AVE
Second Line	:	UPMC CHILDREN'S HOSPITAL OF PITTSBURGH
City	:	PITTSBURGH
State	:	PA
Zip	:	15224-1334
Country	:	US
Telephone Number	:	412-692-5235
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/28/2020
Last Update Date	:	01/29/2026

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