Provider Demographics
NPI:1013008960
Name:PITTELLO, MARYANN (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:MARYANN
Middle Name:
Last Name:PITTELLO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:84 LONGCROSS RD
Mailing Address - Street 2:
Mailing Address - City:LIMERICK
Mailing Address - State:PA
Mailing Address - Zip Code:19468-1395
Mailing Address - Country:US
Mailing Address - Phone:610-208-4717
Mailing Address - Fax:
Practice Address - Street 1:145 N 6TH ST FL 3
Practice Address - Street 2:
Practice Address - City:READING
Practice Address - State:PA
Practice Address - Zip Code:19601-3501
Practice Address - Country:US
Practice Address - Phone:610-208-4717
Practice Address - Fax:610-208-4718
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA002418L363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA014238Medicare ID - Type UnspecifiedMEDICARE BILLING PURPOSES