Healthcare Provider Details

I. General information

NPI: 1013237759
Provider Name (Legal Business Name): ERENY REFAAT GENDY ESKAROUS M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/04/2010
Last Update Date: 06/04/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4175 IVANHOE DR
MONROEVILLE PA
15146
US

IV. Provider business mailing address

4175 IVANHOE DR
MONROEVILLE PA
15146
US

V. Phone/Fax

Practice location:
  • Phone: 330-881-4940
  • Fax:
Mailing address:
  • Phone: 330-881-4940
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMT197597
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: