Healthcare Provider Details

I. General information

NPI: 1154812584
Provider Name (Legal Business Name): MATTHEW MRAZIK RD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/22/2018
Last Update Date: 05/22/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

156 KELVINGTON DR
MONROEVILLE PA
15146-4747
US

IV. Provider business mailing address

156 KELVINGTON DR
MONROEVILLE PA
15146-4747
US

V. Phone/Fax

Practice location:
  • Phone: 412-443-2744
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: