1578562963 NPI number — MCMONAGLE & MURELLO, P.C.

Table of content: (NPI 1881870889)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578562963 NPI number — MCMONAGLE & MURELLO, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MCMONAGLE & MURELLO, P.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1578562963
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/20/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
650 CHERRY TREE LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
UNIONTOWN
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15401-8947
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
724-439-8100
Provider Business Mailing Address Fax Number:
724-439-6217

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
650 CHERRY TREE LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
UNIONTOWN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15401-8947
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-439-8100
Provider Business Practice Location Address Fax Number:
724-439-6217
Provider Enumeration Date:
07/18/2005

Additional Information

Authorized Official

Authorized Official Last Name:
MURELLO
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
M.
Authorized Official Title or Position:
PHYSICIAN/OWNER
Authorized Official Telephone Number:
724-439-8100

Provider Taxonomy Codes

  • Taxonomy code: 207UN0901X , with the licence number:  MD021582-E , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X , with the licence number: MD016826-E , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RC0000X , with the licence number: MD021582-E , 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: 453522 . This is a "BLUE SHIELD/KEYSTONE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 3959 . This is a "MT. STATE BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: CB5080 . This is a "TRAVELERS MEDICARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 001108420 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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