Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152WC0802X | Optomitrist - Corneal and Contact Lenses | OEG001269 | PA |
NPI | 1104041508 |
---|---|
Provider Name | Dr. Monika Agnieszka Marczak |
First Address | Pittsburgh, PA 15243-1635 |
Second Address | Mcmurray, PA 15317-2520 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/04/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U97903 | (02) | PA |