Provider Demographics
NPI:1124026216
Name:MIKNEVICH, MARY ANN (MD)
Entity Type:Individual
Prefix:DR
First Name:MARY ANN
Middle Name:
Last Name:MIKNEVICH
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:PO BOX 598
Mailing Address - Street 2:
Mailing Address - City:WEXFORD
Mailing Address - State:PA
Mailing Address - Zip Code:15090-0598
Mailing Address - Country:US
Mailing Address - Phone:412-622-4314
Mailing Address - Fax:412-622-4882
Practice Address - Street 1:1350 LOCUST ST STE 409
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15219-4738
Practice Address - Country:US
Practice Address - Phone:412-232-7608
Practice Address - Fax:412-281-3536
Is Sole Proprietor?:No
Enumeration Date:2005-07-12
Last Update Date:2022-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD025845E208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0009352390003Medicaid
PA0009352390003Medicaid
C34229Medicare UPIN