Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0131X | Foot Surgery | SC006043 | PA |
NPI | 1104087980 |
---|---|
Provider Name | Mari Elizabeth Wargo-Dorsey |
First Address | Blairsville, PA 15717-8849 |
Second Address | Blairsville, PA 15717-8849 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/06/2008 |
Last Update Date | 23/04/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000834637 | ANTHEM (01) | KY |
201202900 | (05) | IN |
50053192 | PASSPORT HEALTH PLAN (01) | KY |
7100256970 | (05) | KY |