Provider Demographics
NPI:1891768511
Name:MAMATAS, EMANUEL E (MD)
Entity Type:Individual
Prefix:DR
First Name:EMANUEL
Middle Name:E
Last Name:MAMATAS
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 1:6149 SALTSBURG RD
Mailing Address - Street 2:
Mailing Address - City:VERONA
Mailing Address - State:PA
Mailing Address - Zip Code:15147-3542
Mailing Address - Country:US
Mailing Address - Phone:412-924-1130
Mailing Address - Fax:412-924-1136
Practice Address - Street 1:10 DUFF RD STE 212
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15235
Practice Address - Country:US
Practice Address - Phone:412-216-5825
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2018-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD039856L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0010640020002Medicaid
PA194457NHMMedicare PIN
PAB41069Medicare UPIN