Provider Demographics
NPI:1861493850
Name:JANOSKO, MARK RICHARD (MD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:RICHARD
Last Name:JANOSKO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4727 FRIENDSHIP AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15224-1779
Mailing Address - Country:US
Mailing Address - Phone:412-235-5810
Mailing Address - Fax:412-235-5890
Practice Address - Street 1:4727 FRIENDSHIP AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15224-1779
Practice Address - Country:US
Practice Address - Phone:412-235-5810
Practice Address - Fax:412-235-5890
Is Sole Proprietor?:No
Enumeration Date:2005-08-02
Last Update Date:2012-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD053566L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810007060Medicaid
PA0017845780001Medicaid
WV3810007060Medicaid
PA034825NJKMedicare PIN
PA110197213Medicare PIN