Provider Demographics
NPI:1033182142
Name:RAGO, MARY KENDALL (MD)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:KENDALL
Last Name:RAGO
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 1:301 OHIO RIVER BLVD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:SEWICKLEY
Mailing Address - State:PA
Mailing Address - Zip Code:15143-1300
Mailing Address - Country:US
Mailing Address - Phone:412-741-2122
Mailing Address - Fax:412-741-5417
Practice Address - Street 1:301 OHIO RIVER BLVD
Practice Address - Street 2:SUITE 202
Practice Address - City:SEWICKLEY
Practice Address - State:PA
Practice Address - Zip Code:15143-1300
Practice Address - Country:US
Practice Address - Phone:412-741-2122
Practice Address - Fax:412-741-5417
Is Sole Proprietor?:No
Enumeration Date:2006-02-09
Last Update Date:2020-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35087146207Y00000X
WV22164207Y00000X
PAMD427007207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHP00289437OtherRR MEDICARE
PA1018523020001Medicaid
WV3810004695Medicaid
OH2634706Medicaid
OH2634706Medicaid
OHP00289437OtherRR MEDICARE
WV3810004695Medicaid
WV4175823Medicare PIN
OH4175822Medicare PIN
WV4175831Medicare PIN