Healthcare Provider Details

I. General information

NPI: 1053311605
Provider Name (Legal Business Name): JOHN GARY CHENARIDES MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2005
Last Update Date: 10/15/2020
Certification Date: 10/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 E NORTH AVE AGH ELECTROPHYSIOLOGY
PITTSBURGH PA
15212-4756
US

IV. Provider business mailing address

320 E NORTH AVE AGH ELECTROPHYSIOLOGY
PITTSBURGH PA
15212-4756
US

V. Phone/Fax

Practice location:
  • Phone: 412-359-6444
  • Fax: 412-359-6699
Mailing address:
  • Phone: 412-359-6444
  • Fax: 412-359-6699

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberMD045393E
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License NumberMD045393E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: