Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081P2900X | Pain Medicine | MD462629 | PA |
NPI | 1366829558 |
---|---|
Provider Name | Marissa Pfoff Pavlinich |
First Address | Jefferson Hls, PA 15025-3716 |
Second Address | Jefferson Hls, PA 15025-3716 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/04/2015 |
Last Update Date | 18/11/2021 |