1760453740 NPI number — MRS. MARILYN JEAN OBIECUNAS RD, CDE, LDN

Table of content: FADI I ALZEIDAN MD (NPI 1245224724)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760453740 NPI number — MRS. MARILYN JEAN OBIECUNAS RD, CDE, LDN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
OBIECUNAS
Provider First Name:
MARILYN
Provider Middle Name:
JEAN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
RD, CDE, LDN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1760453740
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:
8 POTOMAC AVE
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:
15220-3026
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
412-344-4964
Provider Business Mailing Address Fax Number:
412-344-3776

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2027 LEBANON CHURCH RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WEST MIFFLIN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15122-2461
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
412-344-3776
Provider Business Practice Location Address Fax Number:
412-344-3776
Provider Enumeration Date:
01/30/2006

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: 133V00000X , with the licence number:  DN001366 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2145540 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 5482598 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 13255 . This is a "HEALTHAMERICA" identifier . This identifiers is of the category "OTHER".