Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | MD420804 | PA |
N | 208600000X | Surgeon | MD420804 | PA |
Y | 208G00000X | Cardiothoracic Vascular Surgeon | MD420804 | PA |
NPI | 1033232723 |
---|---|
Provider Name | Mathew A Van Deusen |
First Address | Pittsburgh, PA 15212-4756 |
Second Address | Pittsburgh, PA 15212-4756 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/04/2007 |
Last Update Date | 03/04/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1019385410001 | (05) | PA |
2750698 | (05) | OH |
3810009106 | (05) | WV |