Provider Demographics
NPI:1417230558
Name:DEVITO, MARY ELLEN MARANCIK (LAC)
Entity Type:Individual
Prefix:MRS
First Name:MARY ELLEN
Middle Name:MARANCIK
Last Name:DEVITO
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 SHADY HILL DR
Mailing Address - Street 2:
Mailing Address - City:CHALFONT
Mailing Address - State:PA
Mailing Address - Zip Code:18914-2029
Mailing Address - Country:US
Mailing Address - Phone:215-760-1691
Mailing Address - Fax:
Practice Address - Street 1:148 E STATE ST
Practice Address - Street 2:
Practice Address - City:DOYLESTOWN
Practice Address - State:PA
Practice Address - Zip Code:18901-4313
Practice Address - Country:US
Practice Address - Phone:215-760-1691
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-26
Last Update Date:2011-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAAK001019171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist