Provider Demographics
NPI:1033111778
Name:MITROS, MARK M (M D)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:M
Last Name:MITROS
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:7000 STONEWOOD DR STE 151
Mailing Address - Street 2:
Mailing Address - City:WEXFORD
Mailing Address - State:PA
Mailing Address - Zip Code:15090-7376
Mailing Address - Country:US
Mailing Address - Phone:724-933-0300
Mailing Address - Fax:724-933-0456
Practice Address - Street 1:7000 STONEWOOD DR STE 151
Practice Address - Street 2:
Practice Address - City:WEXFORD
Practice Address - State:PA
Practice Address - Zip Code:15090-7376
Practice Address - Country:US
Practice Address - Phone:724-933-0300
Practice Address - Fax:724-933-0456
Is Sole Proprietor?:No
Enumeration Date:2005-08-12
Last Update Date:2016-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD044629E208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0011906250006Medicaid
PA2203168OtherAETNA HMO
PA593151OtherHIGHMARK
PA4230999OtherAETNA PPO
PA113744OtherHEALTH AMERICA/ASSURANCE
PA1500498OtherGATEWAY HEALTH PLAN
PA252183OtherUPMC HEALTH PLAN
PA1825514AOtherUPMC FOR YOU
PA250010707OtherPALMETTO GBA
PA72441OtherMEDPLUS
PA72441OtherMEDPLUS
PA1500498OtherGATEWAY HEALTH PLAN