Provider Demographics
NPI:1578879367
Name:JOHN C. MENOTIADES. M.D.
Entity Type:Organization
Organization Name:JOHN C. MENOTIADES. M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:C
Authorized Official - Last Name:MENOTIADES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:412-829-7019
Mailing Address - Street 1:106 PENN PLAZA TRIBORO HIGHWAY
Mailing Address - Street 2:
Mailing Address - City:TURTLE CREEK
Mailing Address - State:PA
Mailing Address - Zip Code:15145-1914
Mailing Address - Country:US
Mailing Address - Phone:412-829-7019
Mailing Address - Fax:412-829-1494
Practice Address - Street 1:106 PENN PLAZA TRIBORO HIGHWAY
Practice Address - Street 2:
Practice Address - City:TURTLE CREEK
Practice Address - State:PA
Practice Address - Zip Code:15145-1914
Practice Address - Country:US
Practice Address - Phone:412-829-7019
Practice Address - Fax:412-829-1494
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-31
Last Update Date:2010-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA185533Medicare PIN