Provider Demographics
NPI:1356446603
Name:EGAN, MARY (PH D)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:
Last Name:EGAN
Suffix:
Gender:F
Credentials:PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:519 PENN AVE STE 202
Mailing Address - Street 2:
Mailing Address - City:TURTLE CREEK
Mailing Address - State:PA
Mailing Address - Zip Code:15145-2082
Mailing Address - Country:US
Mailing Address - Phone:412-824-8510
Mailing Address - Fax:412-824-0948
Practice Address - Street 1:519 PENN AVE STE 202
Practice Address - Street 2:
Practice Address - City:TURTLE CREEK
Practice Address - State:PA
Practice Address - Zip Code:15145-2082
Practice Address - Country:US
Practice Address - Phone:412-824-8510
Practice Address - Fax:412-824-0948
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS002123L103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA006180OtherHIGHMARK
PA124692OtherVALUE OPTIONS
PAP00195217OtherMEDICARE RR
PA006180Medicare ID - Type Unspecified