Provider Demographics
NPI:1336184035
Name:BOERIO, MARGARET R IV (DO)
Entity Type:Individual
Prefix:
First Name:MARGARET
Middle Name:R
Last Name:BOERIO
Suffix:IV
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:MARGARET
Other - Middle Name:R
Other - Last Name:ANDROKITES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DO
Mailing Address - Street 1:117 JUNIPER LN
Mailing Address - Street 2:
Mailing Address - City:LIGONIER
Mailing Address - State:PA
Mailing Address - Zip Code:15658-9727
Mailing Address - Country:US
Mailing Address - Phone:724-238-0355
Mailing Address - Fax:724-238-0352
Practice Address - Street 1:117 JUNIPER LN
Practice Address - Street 2:
Practice Address - City:LIGONIER
Practice Address - State:PA
Practice Address - Zip Code:15658-9727
Practice Address - Country:US
Practice Address - Phone:724-238-0355
Practice Address - Fax:724-238-0352
Is Sole Proprietor?:No
Enumeration Date:2006-06-17
Last Update Date:2015-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS006033L2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA013978805Medicaid
706546Medicare PIN
PA013978805Medicaid