Basic Information
| Provider Information | |||||||||
| NPI: | 1033111778 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MITROS | ||||||||
| FirstName: | MARK | ||||||||
| MiddleName: | M. | ||||||||
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| Credential: | M. D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7000 STONEWOOD DR STE 151 | ||||||||
| Address2: | |||||||||
| City: | WEXFORD | ||||||||
| State: | PA | ||||||||
| PostalCode: | 150907376 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7249330300 | ||||||||
| FaxNumber: | 7249330456 | ||||||||
| Practice Location | |||||||||
| Address1: | 7000 STONEWOOD DR STE 151 | ||||||||
| Address2: | |||||||||
| City: | WEXFORD | ||||||||
| State: | PA | ||||||||
| PostalCode: | 150907376 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7249330300 | ||||||||
| FaxNumber: | 7249330456 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/12/2005 | ||||||||
| LastUpdateDate: | 02/05/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208100000X | MD044629E | PA | Y | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation |
ID Information
| ID | Type | State | Issuer | Description | 0011906250006 | 05 | PA | MEDICAID | 2203168 | 01 | PA | AETNA HMO | OTHER | 593151 | 01 | PA | HIGHMARK | OTHER | 4230999 | 01 | PA | AETNA PPO | OTHER | 113744 | 01 | PA | HEALTH AMERICA/ASSURANCE | OTHER | 1500498 | 01 | PA | GATEWAY HEALTH PLAN | OTHER | 252183 | 01 | PA | UPMC HEALTH PLAN | OTHER | 1825514A | 01 | PA | UPMC FOR YOU | OTHER | 250010707 | 01 | PA | PALMETTO GBA | OTHER | 72441 | 01 | PA | MEDPLUS | OTHER |