1689023079 NPI number — DR. MARIE RENEE GEORGE WILLIAMS D.O.

Table of content: LORI SHEVITZ (NPI 1003209990)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689023079 NPI number — DR. MARIE RENEE GEORGE WILLIAMS D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GEORGE WILLIAMS
Provider First Name:
MARIE
Provider Middle Name:
RENEE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.O.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GEORGE
Provider Other First Name:
MARIE
Provider Other Middle Name:
RENEE
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
D.O.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1689023079
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/12/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
134 INDUSTRIAL PARK RD STE 1500
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GREENSBURG
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15601-8153
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
724-850-6933
Provider Business Mailing Address Fax Number:
724-522-4002

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
ONE MELLON WAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LATROBE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15650-1197
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-537-1207
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/07/2016

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: 207Q00000X , with the licence number:  OT016961 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X , with the licence number: OS018986 , 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)