Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213EP1101X | Primary Podiatric Medicine | 36.003434 | OH |
Y | 213ES0103X | Foot & Ankle Surgery | 36.003434 | OH |
NPI | 1114023710 |
---|---|
Provider Name | Dr. Mary Sarah Cernica-Reichard |
First Address | Boardman, OH 44512-4743 |
Second Address | Austintown, OH 44515-4081 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/09/2006 |
Last Update Date | 04/04/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000497906 | ANTHEMBCBS (01) | OH |
2687356 | (05) | OH |
U36983 | (02) | OH |