Provider Demographics
NPI:1205836715
Name:ZERVOS, MARY L (DO)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:L
Last Name:ZERVOS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:969 GREENTREE RD
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15220-3303
Mailing Address - Country:US
Mailing Address - Phone:412-922-5250
Mailing Address - Fax:412-920-8162
Practice Address - Street 1:969 GREENTREE RD
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15220-3303
Practice Address - Country:US
Practice Address - Phone:412-922-5250
Practice Address - Fax:412-920-8162
Is Sole Proprietor?:No
Enumeration Date:2005-07-26
Last Update Date:2011-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA05008697L208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001487878009Medicaid
F97964Medicare UPIN