Healthcare Provider Details

I. General information

NPI: 1770061699
Provider Name (Legal Business Name): MAYRA OSEGUERA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2018
Last Update Date: 04/30/2026
Certification Date: 04/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 E BAYFRONT PKWY STE C
ERIE PA
16507-2410
US

IV. Provider business mailing address

350 E BAYFRONT PKWY STE C
ERIE PA
16507-2410
US

V. Phone/Fax

Practice location:
  • Phone: 814-455-2279
  • Fax:
Mailing address:
  • Phone: 814-455-2279
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberMD495137
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code2080P0210X
TaxonomyPediatric Nephrology Physician
License NumberMD495137
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: