Provider Demographics
NPI:1730809021
Name:DEPTOLA, TRAVIS J (PA-C)
Entity type:Individual
Prefix:
First Name:TRAVIS
Middle Name:J
Last Name:DEPTOLA
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Gender:M
Credentials:PA-C
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:800 CLAIRTON BLVD.
Mailing Address - Street 2:SUITE 100
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15236-4519
Mailing Address - Country:US
Mailing Address - Phone:412-466-5004
Mailing Address - Fax:412-466-7137
Practice Address - Street 1:800 CLAIRTON BLVD.
Practice Address - Street 2:SUITE 100
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15236-4519
Practice Address - Country:US
Practice Address - Phone:412-466-5004
Practice Address - Fax:412-466-7137
Is Sole Proprietor?:No
Enumeration Date:2022-08-29
Last Update Date:2022-08-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAMA063716363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical