Provider Demographics
NPI:1417507484
Name:AMADITZ, MARY Y
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:Y
Last Name:AMADITZ
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:MARY
Other - Middle Name:
Other - Last Name:WITKOWSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6190 IRISHTOWN RD. EXT
Mailing Address - Street 2:
Mailing Address - City:BETHWL PARK
Mailing Address - State:PA
Mailing Address - Zip Code:15102
Mailing Address - Country:US
Mailing Address - Phone:412-835-1701
Mailing Address - Fax:
Practice Address - Street 1:6190 IRISHTOWN RD. EXT
Practice Address - Street 2:
Practice Address - City:BETHWL PARK
Practice Address - State:PA
Practice Address - Zip Code:15102
Practice Address - Country:US
Practice Address - Phone:412-835-1701
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-12
Last Update Date:2019-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care ProviderGroup - Multi-Specialty
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Multi-Specialty
No376J00000XNursing Service Related ProvidersHomemakerGroup - Multi-Specialty