Provider Demographics
NPI:1588663926
Name:MUSMANNO, MARK
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:MUSMANNO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 DELAFIELD RD
Mailing Address - Street 2:SUITE 3060
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15215-3205
Mailing Address - Country:US
Mailing Address - Phone:412-781-6448
Mailing Address - Fax:412-781-1350
Practice Address - Street 1:480 E JEFFERSON ST
Practice Address - Street 2:SUITE C
Practice Address - City:BUTLER
Practice Address - State:PA
Practice Address - Zip Code:16001-4780
Practice Address - Country:US
Practice Address - Phone:724-285-8550
Practice Address - Fax:724-285-8536
Is Sole Proprietor?:No
Enumeration Date:2005-07-19
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD041755L174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0080209OtherAETNA
PA1007305OtherGATEWAY
PA340010862OtherPALMETTO
PA1007305OtherGATEWAY
PA627677Medicare PIN