Provider Demographics
NPI:1225025430
Name:CIENCIVA SORG, ROSEMARIA JUDITH (MD)
Entity Type:Individual
Prefix:
First Name:ROSEMARIA
Middle Name:JUDITH
Last Name:CIENCIVA SORG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:316 W THERESIA RD
Mailing Address - Street 2:
Mailing Address - City:ST MARYS
Mailing Address - State:PA
Mailing Address - Zip Code:15857-2626
Mailing Address - Country:US
Mailing Address - Phone:814-781-6758
Mailing Address - Fax:814-834-1038
Practice Address - Street 1:1095 MILLION DOLLAR HWY
Practice Address - Street 2:
Practice Address - City:SAINT MARYS
Practice Address - State:PA
Practice Address - Zip Code:15857-2743
Practice Address - Country:US
Practice Address - Phone:814-389-1705
Practice Address - Fax:814-389-1706
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-03
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD022377E207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0008758290001Medicaid
PA039893 RAPMedicare ID - Type Unspecified
PAB34094Medicare UPIN
PA0008758290001Medicaid