Healthcare Provider Details

I. General information

NPI: 1659342764
Provider Name (Legal Business Name): MARY LOU TALAMO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

529 RUGH ST
GREENSBURG PA
15601-5615
US

IV. Provider business mailing address

262 LANCEWOOD LN
GREENSBURG PA
15601-5908
US

V. Phone/Fax

Practice location:
  • Phone: 724-837-2550
  • Fax:
Mailing address:
  • Phone: 724-837-2550
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD036844E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: