Healthcare Provider Details

I. General information

NPI: 1437139300
Provider Name (Legal Business Name): LOUIS JOSEPH MARIOTTI D. O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

423 3RD AVE SUITE C
KINGSTON PA
18704-5809
US

IV. Provider business mailing address

423 3RD AVE SUITE C
KINGSTON PA
18704-5809
US

V. Phone/Fax

Practice location:
  • Phone: 570-714-3434
  • Fax: 570-714-6355
Mailing address:
  • Phone: 570-714-3434
  • Fax: 570-714-6355

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0602X
TaxonomyOtolaryngic Allergy Physician
License NumberOS007616L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: