Provider Demographics
NPI:1871596965
Name:NOTARO, JOHN (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:NOTARO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2349 MILL ST
Mailing Address - Street 2:
Mailing Address - City:ALIQUIPPA
Mailing Address - State:PA
Mailing Address - Zip Code:15001-2219
Mailing Address - Country:US
Mailing Address - Phone:724-375-5401
Mailing Address - Fax:724-375-6332
Practice Address - Street 1:2349 MILL ST
Practice Address - Street 2:
Practice Address - City:ALIQUIPPA
Practice Address - State:PA
Practice Address - Zip Code:15001-2219
Practice Address - Country:US
Practice Address - Phone:724-375-5401
Practice Address - Fax:724-375-6332
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2007-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD029324L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA000017045OtherHIGHMARK
PA0008046670003Medicaid
PA000017045OtherHIGHMARK
PA017045PT6Medicare ID - Type Unspecified