Provider Demographics
NPI:1861467821
Name:SOUTH-PAUL, JEANNETTE ELIZABETH (MD)
Entity type:Individual
Prefix:DR
First Name:JEANNETTE
Middle Name:ELIZABETH
Last Name:SOUTH-PAUL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:373 BURROWS ST
Mailing Address - Street 2:UPMC-MATILDA THEISS HEALTH CENTER
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15213-2201
Mailing Address - Country:US
Mailing Address - Phone:412-383-1550
Mailing Address - Fax:
Practice Address - Street 1:373 BURROWS ST
Practice Address - Street 2:UPMC-MATILDA THEISS HEALTH CENTER
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15213-2201
Practice Address - Country:US
Practice Address - Phone:412-383-1550
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD073383L174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAH42558Medicare UPIN
PA049401K1ZMedicare ID - Type Unspecified