Provider Demographics
NPI:1548253149
Name:ATHANAS, MARK D (PA-C, MAT, ATC, EMT)
Entity type:Individual
Prefix:MR
First Name:MARK
Middle Name:D
Last Name:ATHANAS
Suffix:
Gender:M
Credentials:PA-C, MAT, ATC, EMT
Other - Prefix:
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Mailing Address - Street 1:5820 CENTRE AVE
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15206-3710
Mailing Address - Country:US
Mailing Address - Phone:412-661-5500
Mailing Address - Fax:412-661-4365
Practice Address - Street 1:5820 CENTRE AVE
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15206-3710
Practice Address - Country:US
Practice Address - Phone:412-661-5500
Practice Address - Fax:412-661-4365
Is Sole Proprietor?:No
Enumeration Date:2005-08-30
Last Update Date:2013-03-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PART002530A171W00000X
363AM0700X
PAMA053584363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No171W00000XOther Service ProvidersContractor
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical