Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QG0300X | Family Doctor - Geriatric Medicine | MD024267E | PA |
NPI | 1124081369 |
---|---|
Provider Name | Diane Balestrino |
First Address | Pittsburgh, PA 15215-3247 |
Second Address | Pittsburgh, PA 15215-3247 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/04/2006 |
Last Update Date | 25/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E11870 | (02) | PA |