Basic Information
| Provider Information | |||||||||
| NPI: | 1861828873 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | ALLEGHENY CLINIC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | SPYROS I. MARINIS, MD | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1000 HIGBEE DR | ||||||||
| Address2: | SUITE 107 | ||||||||
| City: | BETHEL PARK | ||||||||
| State: | PA | ||||||||
| PostalCode: | 151024200 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4128547145 | ||||||||
| FaxNumber: | 4128547142 | ||||||||
| Practice Location | |||||||||
| Address1: | 1000 HIGBEE DR | ||||||||
| Address2: | SUITE 107 | ||||||||
| City: | BETHEL PARK | ||||||||
| State: | PA | ||||||||
| PostalCode: | 151024200 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4128547145 | ||||||||
| FaxNumber: | 4128547142 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/23/2013 | ||||||||
| LastUpdateDate: | 04/08/2014 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | NOEL | ||||||||
| AuthorizedOfficialFirstName: | DENISE | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | PRACTICE LIASION | ||||||||
| AuthorizedOfficialTelephone: | 4123304938 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | PA | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 100731714 | 05 | PA | MEDICAID |