Provider Demographics
NPI:1073774220
Name:PIKULSKI, MARY ELLEN (DO)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:ELLEN
Last Name:PIKULSKI
Suffix:
Gender:F
Credentials:DO
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1691 HORSE SHOE PIKE STE 4
Mailing Address - Street 2:
Mailing Address - City:GLENMOORE
Mailing Address - State:PA
Mailing Address - Zip Code:19343-1010
Mailing Address - Country:US
Mailing Address - Phone:610-456-7027
Mailing Address - Fax:610-424-7614
Practice Address - Street 1:1691 HORSE SHOE PIKE STE 4
Practice Address - Street 2:
Practice Address - City:GLENMOORE
Practice Address - State:PA
Practice Address - Zip Code:19343-1010
Practice Address - Country:US
Practice Address - Phone:610-456-7027
Practice Address - Fax:610-424-7614
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-20
Last Update Date:2023-05-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PA0T012377207Q00000X
PAOS015519207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102651167Medicaid