Provider Demographics
NPI:1154323756
Name:KOSANOVICH, MITCHELL ANDREW (MD)
Entity Type:Individual
Prefix:DR
First Name:MITCHELL
Middle Name:ANDREW
Last Name:KOSANOVICH
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 1:100 S JACKSON AVE
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15202-3428
Mailing Address - Country:US
Mailing Address - Phone:412-734-6100
Mailing Address - Fax:412-734-6800
Practice Address - Street 1:100 S JACKSON AVE
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15202-3428
Practice Address - Country:US
Practice Address - Phone:412-734-6100
Practice Address - Fax:412-734-6800
Is Sole Proprietor?:No
Enumeration Date:2005-08-12
Last Update Date:2020-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD072543L207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0018311590003Medicaid
OH2355679Medicaid
PA930118703Medicare PIN
PA0018311590003Medicaid
PA045421NJRMedicare PIN
PACG2169Medicare PIN