Provider Demographics
NPI:1063625473
Name:MEDICAL AND ENDOCRINE ASSOCIATES
Entity type:Organization
Organization Name:MEDICAL AND ENDOCRINE ASSOCIATES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SILVANA
Authorized Official - Middle Name:
Authorized Official - Last Name:YOVANOF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:724-258-8680
Mailing Address - Street 1:420 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MONONGAHELA
Mailing Address - State:PA
Mailing Address - Zip Code:15063-2552
Mailing Address - Country:US
Mailing Address - Phone:724-258-8680
Mailing Address - Fax:
Practice Address - Street 1:420 W MAIN ST
Practice Address - Street 2:
Practice Address - City:MONONGAHELA
Practice Address - State:PA
Practice Address - Zip Code:15063-2552
Practice Address - Country:US
Practice Address - Phone:724-258-8680
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-08
Last Update Date:2013-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD046661L174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAMA1423389Medicaid
PAYO416494OtherHIGHMARK BLUE SHIELD
PAYO416494OtherHIGHMARK BLUE SHIELD