Basic Information
| Provider Information | |||||||||
| NPI: | 1093796542 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GREATHOUSE | ||||||||
| FirstName: | MARK | ||||||||
| MiddleName: | KEVIN | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1000 BOWER HILL ROAD | ||||||||
| Address2: | ATTN ST CLAIR HOSPITAL - AFFILIATE BILLING - PAMALYN | ||||||||
| City: | PITTSBURGH | ||||||||
| State: | PA | ||||||||
| PostalCode: | 152431873 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4129422548 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2000 OXFORD DR STE 305 | ||||||||
| Address2: | |||||||||
| City: | BETHEL PARK | ||||||||
| State: | PA | ||||||||
| PostalCode: | 151021841 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4129427900 | ||||||||
| FaxNumber: | 4129427918 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/10/2005 | ||||||||
| LastUpdateDate: | 12/15/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/15/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | MD032259E | PA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
ID Information
| ID | Type | State | Issuer | Description | 73759 | 01 | HEALTH AMERICA | OTHER | P00096580 | 01 | RAILROAD MEDICARE | OTHER | 2174044 | 01 | AETNA | OTHER | 1002326 | 01 | GATEWAY HEALTH PLAN | OTHER | 000000060928 | 01 | UNISON HEALTH PLAN | OTHER | 0012242870001 | 05 | PA | MEDICAID | 512310 | 01 | PA | HIGHMARK BLUE SHIELD | OTHER |