Provider Demographics
NPI:1154575009
Name:JUDITH DIVEN MD PC
Entity type:Organization
Organization Name:JUDITH DIVEN MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JUDITH
Authorized Official - Middle Name:
Authorized Official - Last Name:DIVEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:412-563-5777
Mailing Address - Street 1:520 WASHINGTON RD
Mailing Address - Street 2:STE 203
Mailing Address - City:MOUNT LEBANON
Mailing Address - State:PA
Mailing Address - Zip Code:15228-2819
Mailing Address - Country:US
Mailing Address - Phone:412-563-5777
Mailing Address - Fax:412-563-0122
Practice Address - Street 1:520 WASHINGTON RD
Practice Address - Street 2:STE 203
Practice Address - City:MOUNT LEBANON
Practice Address - State:PA
Practice Address - Zip Code:15228-2819
Practice Address - Country:US
Practice Address - Phone:412-563-5777
Practice Address - Fax:412-563-0122
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-05
Last Update Date:2008-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD018485E2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1451593OtherHIGHMARK