1750417846 NPI number — MRS. MARY CAROL ANTONELLI CRNP

Table of content: MRS. MARY CAROL ANTONELLI CRNP (NPI 1750417846)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750417846 NPI number — MRS. MARY CAROL ANTONELLI CRNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ANTONELLI
Provider First Name:
MARY
Provider Middle Name:
CAROL
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
CRNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
VEREB
Provider Other First Name:
MARY
Provider Other Middle Name:
CAROL
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
CRNP
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1750417846
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
894 MACARTHUR DRIVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PITTSBURGH
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15228
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
412-531-3955
Provider Business Mailing Address Fax Number:
412-692-4313

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3601 FIFTH AVE
Provider Second Line Business Practice Location Address:
FALK MEDICAL BUILDING
Provider Business Practice Location Address City Name:
PITTSBURGH
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15213
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
412-647-6700
Provider Business Practice Location Address Fax Number:
412-692-4313
Provider Enumeration Date:
02/26/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363L00000X , with the licence number:  SP000555C , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363L00000X , with the licence number: ARNP9245928 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)