Provider Demographics
NPI:1114774577
Name:DV PROFESSIONAL GROUP PLLC
Entity type:Organization
Organization Name:DV PROFESSIONAL GROUP PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:GEORGIADES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:412-683-2267
Mailing Address - Street 1:4307 GLADES DR
Mailing Address - Street 2:
Mailing Address - City:ALLISON PARK
Mailing Address - State:PA
Mailing Address - Zip Code:15101-1521
Mailing Address - Country:US
Mailing Address - Phone:412-577-8622
Mailing Address - Fax:
Practice Address - Street 1:4307 GLADES DR
Practice Address - Street 2:
Practice Address - City:ALLISON PARK
Practice Address - State:PA
Practice Address - Zip Code:15101-1521
Practice Address - Country:US
Practice Address - Phone:412-577-8622
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-03
Last Update Date:2024-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty