Provider Demographics
NPI:1063597177
Name:MORETTI, JAMES MICHAEL (MD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:MICHAEL
Last Name:MORETTI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2589 WASHINGTON RD
Mailing Address - Street 2:SUMMERFIELD COMMONS
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15241-2566
Mailing Address - Country:US
Mailing Address - Phone:412-835-5304
Mailing Address - Fax:
Practice Address - Street 1:2589 WASHINGTON RD
Practice Address - Street 2:SUMMERFIELD COMMONS
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15241-2566
Practice Address - Country:US
Practice Address - Phone:412-835-5304
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD024067E207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAB96893Medicare UPIN
PA057299Medicare ID - Type Unspecified