MEDICARE: LORI GAYDOSH

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	363AS0400X	Surgical Physician Assistant	MA000955L	PA

General Provider Information

NPI Number	:	1699817981
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LORI GAYDOSH

Provider Business Mailing Address
First Line	:	200 DELAFIELD RD STE 1040
Second Line	:	SUITE 1040
City	:	PITTSBURGH
State	:	PA
Zip	:	15215-3234
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	200 DELAFIELD RD STE 1040
Second Line	:	SUITE 1040
City	:	PITTSBURGH
State	:	PA
Zip	:	15215-3234
Country	:	US
Telephone Number	:	412-782-3990
Fax Number	:

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

Provider Enumeration Date	:	02/13/2007
Last Update Date	:	03/25/2021

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Directions to “ LORI GAYDOSH ” Practice Location

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