Provider Demographics
NPI:1538120159
Name:ESPOSITO, MARY ANN (DO)
Entity Type:Individual
Prefix:DR
First Name:MARY ANN
Middle Name:
Last Name:ESPOSITO
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 1:1030 REED AVE
Mailing Address - Street 2:
Mailing Address - City:WYOMISSING
Mailing Address - State:PA
Mailing Address - Zip Code:19610-2039
Mailing Address - Country:US
Mailing Address - Phone:610-378-5428
Mailing Address - Fax:610-378-5470
Practice Address - Street 1:1030 REED AVE
Practice Address - Street 2:
Practice Address - City:WYOMISSING
Practice Address - State:PA
Practice Address - Zip Code:19610-2039
Practice Address - Country:US
Practice Address - Phone:610-378-5428
Practice Address - Fax:610-378-5470
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2010-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS011962207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01956618Medicaid
O71782Medicare UPIN
H90411Medicare UPIN
PA01956618Medicaid