Provider Demographics
NPI:1861438129
Name:ZACCAGNINI, DOREEN
Entity type:Individual
Prefix:
First Name:DOREEN
Middle Name:
Last Name:ZACCAGNINI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6500 STEUBENVILLE PIKE
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15205-1006
Mailing Address - Country:US
Mailing Address - Phone:412-788-1002
Mailing Address - Fax:412-787-3475
Practice Address - Street 1:6500 STEUBENVILLE PIKE
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15205-1006
Practice Address - Country:US
Practice Address - Phone:412-788-1002
Practice Address - Fax:412-787-3475
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2021-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAUP004713B363L00000X
PAUP004731B363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA004837Medicare ID - Type Unspecified
PAS48389Medicare UPIN