Provider Demographics
NPI:1093796542
Name:GREATHOUSE, MARK KEVIN (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:KEVIN
Last Name:GREATHOUSE
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 1:200 QUINN DR
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15275-1055
Mailing Address - Country:US
Mailing Address - Phone:412-264-9500
Mailing Address - Fax:412-264-8999
Practice Address - Street 1:200 QUINN DR
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15275-1055
Practice Address - Country:US
Practice Address - Phone:421-264-9500
Practice Address - Fax:412-264-8999
Is Sole Proprietor?:No
Enumeration Date:2005-11-10
Last Update Date:2024-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD032259E207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
1002326OtherGATEWAY HEALTH PLAN
PA512310OtherHIGHMARK BLUE SHIELD
73759OtherHEALTH AMERICA
PA2O4278OtherMEDICARE PIN
PA0012242870001Medicaid
P00096580OtherRAILROAD MEDICARE
000000060928OtherUNISON HEALTH PLAN
2174044OtherAETNA
P00096580OtherRAILROAD MEDICARE