MEDICARE: MRS. MARY L ZERVOS DO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	05008697L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1205836715
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MARY L ZERVOS DO

Provider Business Mailing Address
First Line	:	969 GREENTREE RD
Second Line	:
City	:	PITTSBURGH
State	:	PA
Zip	:	15220-3303
Country	:	US
Telephone Number	:	412-922-5250
Fax Number	:	412-920-8162

Provider Business Practice Location Address
First Line	:	969 GREENTREE RD
Second Line	:
City	:	PITTSBURGH
State	:	PA
Zip	:	15220-3303
Country	:	US
Telephone Number	:	412-922-5250
Fax Number	:	412-920-8162

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/26/2005
Last Update Date	:	08/30/2011

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