Provider Demographics
NPI:1275533689
Name:DECARO, MARY M (MD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:M
Last Name:DECARO
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:1088 W BALTIMORE PIKE
Mailing Address - Street 2:SUITE 2208
Mailing Address - City:MEDIA
Mailing Address - State:PA
Mailing Address - Zip Code:19063-5146
Mailing Address - Country:US
Mailing Address - Phone:484-565-8500
Mailing Address - Fax:610-280-1595
Practice Address - Street 1:1088 W BALTIMORE PIKE
Practice Address - Street 2:SUITE 2208
Practice Address - City:MEDIA
Practice Address - State:PA
Practice Address - Zip Code:19063-5146
Practice Address - Country:US
Practice Address - Phone:484-565-8500
Practice Address - Fax:610-280-1595
Is Sole Proprietor?:No
Enumeration Date:2005-07-28
Last Update Date:2016-02-19
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Provider Licenses
StateLicense IDTaxonomies
PAMD041724L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAE88347Medicare UPIN
PA675545HK1Medicare PIN