Provider Demographics
NPI:1326018607
Name:PIERGALLINI, MARY ELIZABETH (MD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:ELIZABETH
Last Name:PIERGALLINI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:401 HIGH ST
Mailing Address - Street 2:
Mailing Address - City:LOCK HAVEN
Mailing Address - State:PA
Mailing Address - Zip Code:17745-3013
Mailing Address - Country:US
Mailing Address - Phone:570-748-7400
Mailing Address - Fax:570-748-8004
Practice Address - Street 1:401 HIGH ST
Practice Address - Street 2:
Practice Address - City:LOCK HAVEN
Practice Address - State:PA
Practice Address - Zip Code:17745-3013
Practice Address - Country:US
Practice Address - Phone:570-747-7400
Practice Address - Fax:570-748-8004
Is Sole Proprietor?:No
Enumeration Date:2006-01-26
Last Update Date:2022-04-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD421135207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0019525750001Medicaid
PA0019525750001Medicaid
PAF40839Medicare UPIN
PA0019525750001Medicaid