Provider Demographics
NPI:1043608391
Name:MARY ANN DIBIAGIO, D.O., PC
Entity Type:Organization
Organization Name:MARY ANN DIBIAGIO, D.O., PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARY ANN
Authorized Official - Middle Name:
Authorized Official - Last Name:DIBIAGIO
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:724-758-7559
Mailing Address - Street 1:163 CHAPEL DR
Mailing Address - Street 2:
Mailing Address - City:ELLWOOD CITY
Mailing Address - State:PA
Mailing Address - Zip Code:16117-5003
Mailing Address - Country:US
Mailing Address - Phone:724-758-7559
Mailing Address - Fax:
Practice Address - Street 1:163 CHAPEL DR
Practice Address - Street 2:
Practice Address - City:ELLWOOD CITY
Practice Address - State:PA
Practice Address - Zip Code:16117-5003
Practice Address - Country:US
Practice Address - Phone:724-758-7559
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-08
Last Update Date:2015-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS005303L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0009552780004Medicaid
PA094524Medicare PIN