Provider Demographics
NPI:1972558815
Name:ITZKOFF, JEROME M (MD)
Entity type:Individual
Prefix:DR
First Name:JEROME
Middle Name:M
Last Name:ITZKOFF
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5200 CENTRE AVE
Mailing Address - Street 2:SUITE 710
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15232-1300
Mailing Address - Country:US
Mailing Address - Phone:412-621-5000
Mailing Address - Fax:412-621-1804
Practice Address - Street 1:5200 CENTRE AVE
Practice Address - Street 2:SUITE 710
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15232-1300
Practice Address - Country:US
Practice Address - Phone:412-621-5000
Practice Address - Fax:412-621-1804
Is Sole Proprietor?:No
Enumeration Date:2006-05-22
Last Update Date:2007-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD 020427-E207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102465OtherUPMC FOR YOU
PA1013041OtherGATEWAY HEALTH PLAN
PA000000066228OtherUNISON HEALTH PLAN
PA00114147190006Medicaid
PA0012138000OtherINDEPENDENT BLUE SHIELD
PA65990OtherFIRST HEALTH
PA1013041OtherGATEWAY HEALTH PLAN
PA00114147190006Medicaid