Basic Information
| Provider Information | |||||||||
| NPI: | 1124014584 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | STYPULA | ||||||||
| FirstName: | MARK | ||||||||
| MiddleName: | O | ||||||||
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| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 4800 FRIENDSHIP AVE | ||||||||
| Address2: | |||||||||
| City: | PITTSBURGH | ||||||||
| State: | PA | ||||||||
| PostalCode: | 152241722 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4125785323 | ||||||||
| FaxNumber: | 4126056425 | ||||||||
| Practice Location | |||||||||
| Address1: | 4800 FRIENDSHIP AVE | ||||||||
| Address2: | |||||||||
| City: | PITTSBURGH | ||||||||
| State: | PA | ||||||||
| PostalCode: | 152241722 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4125785323 | ||||||||
| FaxNumber: | 4126056425 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/21/2005 | ||||||||
| LastUpdateDate: | 10/19/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | 10/19/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | MD037322E | PA | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 0772034 | 05 | OH | MEDICAID | P00316200 | 01 | PA | RAILROAD MEDICARE | OTHER | 1805830000 | 05 | WV | MEDICAID | 0011567680012 | 05 | PA | MEDICAID | 1156768 | 05 | PA | MEDICAID |