Healthcare Provider Details

I. General information

NPI: 1093722472
Provider Name (Legal Business Name): MARK A. PIASIO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 06/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

145 HOSPITAL AVE SUITE 311
DU BOIS PA
15801-1462
US

IV. Provider business mailing address

PO BOX 447
DU BOIS PA
15801-0447
US

V. Phone/Fax

Practice location:
  • Phone: 814-375-9617
  • Fax: 814-375-9624
Mailing address:
  • Phone: 814-375-9617
  • Fax: 814-375-9624

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberMD-043778-E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: