Provider Demographics
NPI:1083615322
Name:SANGIMINO, MARK JOSEPH (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:JOSEPH
Last Name:SANGIMINO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12620 PERRY HWY # 2
Mailing Address - Street 2:
Mailing Address - City:WEXFORD
Mailing Address - State:PA
Mailing Address - Zip Code:15090-8662
Mailing Address - Country:US
Mailing Address - Phone:724-933-6699
Mailing Address - Fax:412-359-8055
Practice Address - Street 1:12620 PERRY HWY # 2
Practice Address - Street 2:
Practice Address - City:WEXFORD
Practice Address - State:PA
Practice Address - Zip Code:15090-8662
Practice Address - Country:US
Practice Address - Phone:724-933-6699
Practice Address - Fax:412-359-8055
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2020-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD059006L207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0015936740007Medicaid
PA0015936740009Medicaid
OH0272628Medicaid
WV1807593000Medicaid
PA0015936740014Medicaid
PA0015936740014Medicaid
OH0272628Medicaid