Provider Demographics
NPI:1780625087
Name:HOUSTON, MARYJO A (MD)
Entity type:Individual
Prefix:DR
First Name:MARYJO
Middle Name:A
Last Name:HOUSTON
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 1:3824 NORTHERN PIKE
Mailing Address - Street 2:SUITE 700
Mailing Address - City:MONROEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15146-2141
Mailing Address - Country:US
Mailing Address - Phone:412-457-0060
Mailing Address - Fax:
Practice Address - Street 1:310 RODI RD
Practice Address - Street 2:SUITE 100
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15235-3318
Practice Address - Country:US
Practice Address - Phone:412-242-0777
Practice Address - Fax:412-242-5174
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2020-02-11
Deactivation Date:2019-09-19
Deactivation Code:
Reactivation Date:2020-02-11
Provider Licenses
StateLicense IDTaxonomies
PAMD036534E207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
080172837OtherRAILROAD MEDICARE
P000250OtherGATEWAY HEALTH PLAN
PA001123088Medicaid
133764OtherBLUE SHIELD
205766OtherUPMC HEALTH PLAN
4070665OtherAETNA
P000250OtherGATEWAY HEALTH PLAN
PA001123088Medicaid
4070665OtherAETNA