Provider Demographics
NPI:1396839270
Name:KRUSZEWSKI, MARY CATHERINE (DO)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:CATHERINE
Last Name:KRUSZEWSKI
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:132 ABIGAIL LN
Mailing Address - Street 2:
Mailing Address - City:PORT MATILDA
Mailing Address - State:PA
Mailing Address - Zip Code:16870-7153
Mailing Address - Country:US
Mailing Address - Phone:814-272-7100
Mailing Address - Fax:814-272-6507
Practice Address - Street 1:132 ABIGAIL LN
Practice Address - Street 2:
Practice Address - City:PORT MATILDA
Practice Address - State:PA
Practice Address - Zip Code:16870-7153
Practice Address - Country:US
Practice Address - Phone:814-272-7100
Practice Address - Fax:814-272-6507
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2011-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS007099L207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA733407OtherHIGHMARK BC BS
PA0014048010003Medicaid
PA211325OtherUPMC HEALTH PLAN
PA733407OtherHIGHMARK BC BS
PAF51544Medicare UPIN