1346442027 NPI number — MARY LYNNE ROMANIC-FEDOR DPT

Table of content: MARY LYNNE ROMANIC-FEDOR DPT (NPI 1346442027)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346442027 NPI number — MARY LYNNE ROMANIC-FEDOR DPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROMANIC-FEDOR
Provider First Name:
MARY
Provider Middle Name:
LYNNE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DPT
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:
1346442027
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 15
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BYRNEDALE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15827-0015
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
412-780-6417
Provider Business Mailing Address Fax Number:
304-723-7173

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3045 PENNSYLVANIA AVE
Provider Second Line Business Practice Location Address:
SUITE 8
Provider Business Practice Location Address City Name:
WEIRTON
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
26062-3770
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-723-7111
Provider Business Practice Location Address Fax Number:
304-723-7173
Provider Enumeration Date:
06/04/2007

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: 225100000X , with the licence number:  PT2633 , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 225100000X , with the licence number: 011190 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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