Provider Demographics
NPI:1366829558
Name:PAVLINICH, MARISSA PFOFF (MD)
Entity Type:Individual
Prefix:
First Name:MARISSA
Middle Name:PFOFF
Last Name:PAVLINICH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MARISSA
Other - Middle Name:KIRSTIN
Other - Last Name:PFOFF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:575 COAL VALLEY RD STE 277
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON HLS
Mailing Address - State:PA
Mailing Address - Zip Code:15025-3716
Mailing Address - Country:US
Mailing Address - Phone:412-469-7722
Mailing Address - Fax:
Practice Address - Street 1:575 COAL VALLEY RD STE 277
Practice Address - Street 2:
Practice Address - City:JEFFERSON HLS
Practice Address - State:PA
Practice Address - Zip Code:15025-3716
Practice Address - Country:US
Practice Address - Phone:412-469-7722
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-27
Last Update Date:2021-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
PAMD4626292081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Single Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty