Provider Demographics
NPI:1285656785
Name:MITZEL, TIMOTHY S (DO)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:S
Last Name:MITZEL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4900 PERRY HWY STE 1
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15229-2236
Mailing Address - Country:US
Mailing Address - Phone:412-683-0756
Mailing Address - Fax:412-301-0441
Practice Address - Street 1:4900 PERRY HWY STE 1
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15229-2236
Practice Address - Country:US
Practice Address - Phone:412-307-5600
Practice Address - Fax:412-301-0441
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2019-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS006035-L2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA673053OtherBLUE CROSS BLUE SHIELD PA
PA0012615110002Medicaid
PA631569OtherHIGHMARK
PA110288OtherUPMC
C33520Medicare UPIN
PA0012615110002Medicaid
PA673053Medicare PIN