Provider Demographics
NPI:1497246342
Name:MAMARIL, AL LIANDRO (DO)
Entity Type:Individual
Prefix:DR
First Name:AL
Middle Name:LIANDRO
Last Name:MAMARIL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:MR
Other - First Name:AL
Other - Middle Name:LIANDRO
Other - Last Name:MAMARIL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DO
Mailing Address - Street 1:1070 OLD NATIONAL PIKE
Mailing Address - Street 2:
Mailing Address - City:FREDERICKTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15333-2114
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:718 MCKEAN AVE
Practice Address - Street 2:
Practice Address - City:DONORA
Practice Address - State:PA
Practice Address - Zip Code:15033-1061
Practice Address - Country:US
Practice Address - Phone:724-379-4401
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-27
Last Update Date:2023-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOT018280390200000X
PAOS021503207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program