Provider Demographics
NPI:1770565285
Name:PAYNE, MARYANN E (MD)
Entity type:Individual
Prefix:
First Name:MARYANN
Middle Name:E
Last Name:PAYNE
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 1:2 HOT METAL ST
Mailing Address - Street 2:QUANTUM ONE, SUITE 001
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15203-2348
Mailing Address - Country:US
Mailing Address - Phone:412-647-3087
Mailing Address - Fax:724-347-4782
Practice Address - Street 1:875 N HERMITAGE RD
Practice Address - Street 2:SUITE 2
Practice Address - City:HERMITAGE
Practice Address - State:PA
Practice Address - Zip Code:16148-3278
Practice Address - Country:US
Practice Address - Phone:724-347-4847
Practice Address - Fax:724-347-4782
Is Sole Proprietor?:No
Enumeration Date:2005-11-18
Last Update Date:2017-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD057292L208G00000X
NY244802174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAG63534Medicare UPIN