Provider Demographics
NPI:1043249683
Name:PLAZA-PONTE, MARIO T (MD)
Entity Type:Individual
Prefix:DR
First Name:MARIO
Middle Name:T
Last Name:PLAZA-PONTE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2550 MOSSIDE BLVD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:MONROEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15146-3540
Mailing Address - Country:US
Mailing Address - Phone:412-373-9580
Mailing Address - Fax:412-373-9582
Practice Address - Street 1:2550 MOSSIDE BLVD
Practice Address - Street 2:SUITE 105
Practice Address - City:MONROEVILLE
Practice Address - State:PA
Practice Address - Zip Code:15146-3530
Practice Address - Country:US
Practice Address - Phone:412-373-9580
Practice Address - Fax:412-373-9582
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-03
Last Update Date:2008-11-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAMD028210E202K00000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes202K00000XAllopathic & Osteopathic PhysiciansPhlebology
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAB34734Medicare UPIN
PA065747ZASMMedicare PIN