MEDICARE: MARITA PYANKOV

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker

General Provider Information

NPI Number	:	1013583236
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARITA PYANKOV

Provider Business Mailing Address
First Line	:	308 E LANCASTER AVE STE 200
Second Line	:
City	:	WYNNEWOOD
State	:	PA
Zip	:	19096-2145
Country	:	US
Telephone Number	:	484-679-6299
Fax Number	:

Provider Business Practice Location Address
First Line	:	308 E LANCASTER AVE STE 200
Second Line	:
City	:	WYNNEWOOD
State	:	PA
Zip	:	19096-2145
Country	:	US
Telephone Number	:	484-679-6299
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/28/2021
Last Update Date	:	05/28/2021

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