Provider Demographics
NPI:1912942939
Name:PAVLICK, GENO JOSEPH (MD)
Entity Type:Individual
Prefix:DR
First Name:GENO
Middle Name:JOSEPH
Last Name:PAVLICK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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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:2006-06-17
Last Update Date:2020-11-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD059655L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
P000130OtherGATEWAY HEALTH PLAN
202461OtherVPMC HEALTH PLAN
PA001651633Medicaid
5181567OtherAETNA
080172838OtherRAILROAD MEDICARE
954623OtherBLUE SHIELD
PA001651633Medicaid
P000130OtherGATEWAY HEALTH PLAN
PA954623Medicare PIN