Provider Demographics
NPI:1750417846
Name:ANTONELLI, MARY CAROL (CRNP)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:CAROL
Last Name:ANTONELLI
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:CAROL
Other - Last Name:VEREB
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CRNP
Mailing Address - Street 1:894 MACARTHUR DRIVE
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15228
Mailing Address - Country:US
Mailing Address - Phone:412-531-3955
Mailing Address - Fax:412-692-4313
Practice Address - Street 1:3601 FIFTH AVE
Practice Address - Street 2:FALK MEDICAL BUILDING
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15213
Practice Address - Country:US
Practice Address - Phone:412-647-6700
Practice Address - Fax:412-692-4313
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP000555C363L00000X
FLARNP9245928363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
564061Medicare UPIN
PA019122Medicare ID - Type Unspecified