Healthcare Provider Details

I. General information

NPI: 1851971824
Provider Name (Legal Business Name): MARA KIRSTIMEL LI GASANG BANEZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2021
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3824 NORTHERN PIKE STE 415
MONROEVILLE PA
15146-2162
US

IV. Provider business mailing address

3824 NORTHERN PIKE STE 415
MONROEVILLE PA
15146-2162
US

V. Phone/Fax

Practice location:
  • Phone: 412-858-3017
  • Fax: 412-856-5871
Mailing address:
  • Phone: 412-858-3017
  • Fax: 412-856-5871

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License NumberMD496819
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: