Provider Demographics
NPI:1528169943
Name:IANNAZZI, JAMES A (MD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:A
Last Name:IANNAZZI
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 1:850 HOSPITAL ROAD
Mailing Address - Street 2:SUITE 2200
Mailing Address - City:INDIANA
Mailing Address - State:PA
Mailing Address - Zip Code:15701-3663
Mailing Address - Country:US
Mailing Address - Phone:724-464-0270
Mailing Address - Fax:724-464-0274
Practice Address - Street 1:850 HOSPITAL ROAD
Practice Address - Street 2:SUITE 2200
Practice Address - City:INDIANA
Practice Address - State:PA
Practice Address - Zip Code:15701-3663
Practice Address - Country:US
Practice Address - Phone:724-464-0270
Practice Address - Fax:724-464-0274
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2021-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD4528442084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
G83212Medicare UPIN
MM7374Medicare ID - Type Unspecified