Provider Demographics
NPI:1730282195
Name:MENOTIADES, JOHN C (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:C
Last Name:MENOTIADES
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 1:1165 JEFFERSON HEIGHTS RD
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15235-4710
Mailing Address - Country:US
Mailing Address - Phone:412-372-6816
Mailing Address - Fax:
Practice Address - Street 1:PENN PLAZA
Practice Address - Street 2:
Practice Address - City:TURTLE CREEK
Practice Address - State:PA
Practice Address - Zip Code:15145
Practice Address - Country:US
Practice Address - Phone:412-829-7019
Practice Address - Fax:412-829-1494
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD038837L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA089004800001Medicaid
PA100752OtherUPMC HEALTH PLAN
PA185533Medicare ID - Type Unspecified
PA100752OtherUPMC HEALTH PLAN