Provider Demographics
NPI:1184670051
Name:PANAYIDES, MARIOS PETROUS (MD)
Entity Type:Individual
Prefix:
First Name:MARIOS
Middle Name:PETROUS
Last Name:PANAYIDES
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 1:2275 SWALLOW HILL RD SUITE 2400
Mailing Address - Street 2:THE SKIN CENTER
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15220-1676
Mailing Address - Country:US
Mailing Address - Phone:412-429-1151
Mailing Address - Fax:412-429-0211
Practice Address - Street 1:30 WARDER ST
Practice Address - Street 2:SUITE 220
Practice Address - City:SPRINGFIELD
Practice Address - State:OH
Practice Address - Zip Code:45504-2500
Practice Address - Country:US
Practice Address - Phone:937-399-7021
Practice Address - Fax:937-399-0697
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2015-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-03-3769-P208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH02566986Medicaid
OH02566986Medicaid
OHPA0401983Medicare ID - Type Unspecified