Provider Demographics
NPI:1225162654
Name:PONTZER, MARY G (MD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:G
Last Name:PONTZER
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 1:11676 PERRY HWY STE 2309
Mailing Address - Street 2:
Mailing Address - City:WEXFORD
Mailing Address - State:PA
Mailing Address - Zip Code:15090-7200
Mailing Address - Country:US
Mailing Address - Phone:724-935-6920
Mailing Address - Fax:724-935-6921
Practice Address - Street 1:11676 PERRY HWY STE 2309
Practice Address - Street 2:
Practice Address - City:WEXFORD
Practice Address - State:PA
Practice Address - Zip Code:15090-7200
Practice Address - Country:US
Practice Address - Phone:724-935-6920
Practice Address - Fax:724-935-6921
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD-024953E2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry