Provider Demographics
NPI:1598757866
Name:LOVERANES, MARIANO DULAY (MD)
Entity Type:Individual
Prefix:
First Name:MARIANO
Middle Name:DULAY
Last Name:LOVERANES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:706 WORTH ST
Mailing Address - Street 2:13466 ROUTE 6
Mailing Address - City:CORRY
Mailing Address - State:PA
Mailing Address - Zip Code:16407-8517
Mailing Address - Country:US
Mailing Address - Phone:814-664-2666
Mailing Address - Fax:814-664-8931
Practice Address - Street 1:706 WORTH ST
Practice Address - Street 2:
Practice Address - City:CORRY
Practice Address - State:PA
Practice Address - Zip Code:16407-8517
Practice Address - Country:US
Practice Address - Phone:814-664-2666
Practice Address - Fax:814-664-8931
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-22
Last Update Date:2010-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAAL 9368792208000000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0872685Medicaid
PA0872685Medicaid
B36819Medicare UPIN