1497246342 NPI number — DR. AL LIANDRO MAMARIL DO

Table of content: DR. AL LIANDRO MAMARIL DO (NPI 1497246342)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497246342 NPI number — DR. AL LIANDRO MAMARIL DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MAMARIL
Provider First Name:
AL
Provider Middle Name:
LIANDRO
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DO
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MAMARIL
Provider Other First Name:
AL
Provider Other Middle Name:
LIANDRO
Provider Other Name Prefix Text:
MR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
DO
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1497246342
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/19/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1070 OLD NATIONAL PIKE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FREDERICKTOWN
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15333-2114
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
718 MCKEAN AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DONORA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15033-1061
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-379-4401
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/27/2018

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 390200000X , with the licence number:  OT018280 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X , with the licence number: OS021503 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com