Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | DC-002574-L | PA |
NPI | 1285607945 |
---|---|
Provider Name | Dr. Jeffrey K Marsalese |
First Address | Pittsburgh, PA 15239-2218 |
Second Address | Murrysville, PA 15668-9774 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/02/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
201961 | UPMC (01) | PA |
T28114 | (02) | PA |