Provider Demographics
NPI:1710975461
Name:MAVRINAC, JOAN MICHELE (MD)
Entity Type:Individual
Prefix:
First Name:JOAN
Middle Name:MICHELE
Last Name:MAVRINAC
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4800 FRIENDSHIP AVE
Mailing Address - Street 2:EMERG MED WESTERN PENNA HOSPITAL
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15224-1722
Mailing Address - Country:US
Mailing Address - Phone:412-578-5442
Mailing Address - Fax:412-578-1144
Practice Address - Street 1:4800 FRIENDSHIP AVE
Practice Address - Street 2:EMERG MED WESTERN PENNA HOSPITAL
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15224-1722
Practice Address - Country:US
Practice Address - Phone:412-578-5442
Practice Address - Fax:412-578-1144
Is Sole Proprietor?:No
Enumeration Date:2005-10-07
Last Update Date:2010-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD036140E207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0011874050003Medicaid
WV3810008858Medicaid
OH2747139Medicaid
PA930123040Medicare PIN
OH2747139Medicaid
PA429137GXFMedicare PIN
WV3810008858Medicaid