Provider Demographics
NPI:1053383570
Name:DEVINE, JOAN M (MD)
Entity type:Individual
Prefix:DR
First Name:JOAN
Middle Name:M
Last Name:DEVINE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1307 FEDERAL ST STE B300
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15212-4775
Mailing Address - Country:US
Mailing Address - Phone:412-359-3751
Mailing Address - Fax:412-359-8439
Practice Address - Street 1:1307 FEDERAL ST STE B300
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15212-4775
Practice Address - Country:US
Practice Address - Phone:412-359-3751
Practice Address - Fax:412-359-8439
Is Sole Proprietor?:No
Enumeration Date:2006-02-07
Last Update Date:2020-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD026314E207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001148354Medicaid
PA001148354Medicaid
PAE63591Medicare UPIN