Provider Demographics
NPI:1467428094
Name:CERTO-ROSSETTI, MARY LORI (DO)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:LORI
Last Name:CERTO-ROSSETTI
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Gender:F
Credentials:DO
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Mailing Address - Street 1:5375 WILLIAM FLYNN HWY
Mailing Address - Street 2:RICHLAND MALL
Mailing Address - City:GIBSONIA
Mailing Address - State:PA
Mailing Address - Zip Code:15044-9666
Mailing Address - Country:US
Mailing Address - Phone:724-444-4700
Mailing Address - Fax:724-444-4730
Practice Address - Street 1:5375 WILLIAM FLYNN HWY
Practice Address - Street 2:RICHLAND MALL
Practice Address - City:GIBSONIA
Practice Address - State:PA
Practice Address - Zip Code:15044-9666
Practice Address - Country:US
Practice Address - Phone:724-444-4700
Practice Address - Fax:724-444-4730
Is Sole Proprietor?:No
Enumeration Date:2006-02-24
Last Update Date:2020-10-09
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Provider Licenses
StateLicense IDTaxonomies
PAOS012303207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0019125700005Medicaid
PA063095Medicare PIN
PA0019125700005Medicaid