Provider Demographics
NPI:1861843088
Name:PIERSANTE, MARIA E (PA-C)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:E
Last Name:PIERSANTE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:822 E WESTERN RESERVE RD
Mailing Address - Street 2:
Mailing Address - City:POLAND
Mailing Address - State:OH
Mailing Address - Zip Code:44514-3359
Mailing Address - Country:US
Mailing Address - Phone:330-758-8223
Mailing Address - Fax:330-758-6993
Practice Address - Street 1:822 E WESTERN RESERVE RD
Practice Address - Street 2:
Practice Address - City:POLAND
Practice Address - State:OH
Practice Address - Zip Code:44514-3359
Practice Address - Country:US
Practice Address - Phone:330-758-8223
Practice Address - Fax:330-758-6993
Is Sole Proprietor?:No
Enumeration Date:2016-06-29
Last Update Date:2016-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50.004675RX363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical