Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | MD044629E | PA |
NPI | 1033111778 |
---|---|
Provider Name | Mark M. Mitros |
First Address | Wexford, PA 15090-7376 |
Second Address | Wexford, PA 15090-7376 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/08/2005 |
Last Update Date | 05/02/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0011906250006 | (05) | PA |
113744 | HEALTH AMERICA/ASSURANCE (01) | PA |
1500498 | GATEWAY HEALTH PLAN (01) | PA |
1825514A | UPMC FOR YOU (01) | PA |
2203168 | AETNA HMO (01) | PA |
250010707 | PALMETTO GBA (01) | PA |
252183 | UPMC HEALTH PLAN (01) | PA |
4230999 | AETNA PPO (01) | PA |
593151 | HIGHMARK (01) | PA |
72441 | MEDPLUS (01) | PA |
D81880 | (02) | PA |