Basic Information
| Provider Information | |||||||||
| NPI: | 1437120441 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GEORGIADIS | ||||||||
| FirstName: | MARK | ||||||||
| MiddleName: | S | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2 HOT METAL ST | ||||||||
| Address2: | QUANTUM ONE, N430 | ||||||||
| City: | PITTSBURGH | ||||||||
| State: | PA | ||||||||
| PostalCode: | 152032348 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4124327706 | ||||||||
| FaxNumber: | 4124327691 | ||||||||
| Practice Location | |||||||||
| Address1: | 200 DELAFIELD RD | ||||||||
| Address2: | SUITE 3050 | ||||||||
| City: | PITTSBURGH | ||||||||
| State: | PA | ||||||||
| PostalCode: | 152153205 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4127813744 | ||||||||
| FaxNumber: | 4127813793 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/28/2006 | ||||||||
| LastUpdateDate: | 12/06/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RH0003X | MD061189L | PA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology |
ID Information
| ID | Type | State | Issuer | Description | 10765060 | 01 | PA | CAQH | OTHER | 0016407830005 | 05 | PA | MEDICAID | 902487 | 01 | PA | HIGHMARK BS | OTHER |