1588741003 NPI number — MARIA J. SUNSERI, M.D. L.L.C.

Table of content: (NPI 1588741003)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588741003 NPI number — MARIA J. SUNSERI, M.D. L.L.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MARIA J. SUNSERI, M.D. L.L.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:
1588741003
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/27/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4815 LIBERTY AVE STE 120
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:
15224-2156
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
412-781-2023
Provider Business Mailing Address Fax Number:
412-727-7842

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4815 LIBERTY AVE
Provider Second Line Business Practice Location Address:
STE M-02
Provider Business Practice Location Address City Name:
PITTSBURGH
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15224-2156
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
412-781-2023
Provider Business Practice Location Address Fax Number:
412-727-7842
Provider Enumeration Date:
11/01/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SUNSERI
Authorized Official First Name:
MARIA
Authorized Official Middle Name:
J.
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
412-781-2023

Provider Taxonomy Codes

  • Taxonomy code: 2084N0400X , with the licence number:  MD 047961L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084N0400X , with the licence number: 216849 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084N0600X , with the licence number: MD 047961 L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084N0600X , with the licence number: 216849 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084S0012X , with the licence number: 216849 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084S0012X , with the licence number: MD 047961L , 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: 9088664 . This is a "AETNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: TIN . This is a "CIGNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 271227 . This is a "MEDICARE PTAN" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1028450170001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1492414 . This is a "HIGHMARK BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 227451 . This is a "COVENTRY (HAM, HA, ADV, COV CARES)" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1539350 . This is a "GATEWAY HEALTH PLAN" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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