Healthcare Provider Details

I. General information

NPI: 1184685786
Provider Name (Legal Business Name): ROBERT N. MITRO D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2006
Last Update Date: 07/11/2025
Certification Date: 07/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 BROOKS LN STE 285
CLAIRTON PA
15025-3764
US

IV. Provider business mailing address

1200 BROOKS LN STE 285
CLAIRTON PA
15025-3764
US

V. Phone/Fax

Practice location:
  • Phone: 412-384-1644
  • Fax: 412-246-4567
Mailing address:
  • Phone: 412-384-1644
  • Fax: 412-246-4567

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberOS0047002L
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier0009656770002
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: