Healthcare Provider Details

I. General information

NPI: 1023117405
Provider Name (Legal Business Name): MARCY J ZOLLER CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 04/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5200 CENTRE AVE STE 610
PITTSBURGH PA
15232-1326
US

IV. Provider business mailing address

109 S ATLANTIC AVE
CHESWICK PA
15024-1605
US

V. Phone/Fax

Practice location:
  • Phone: 412-621-1200
  • Fax: 412-621-9958
Mailing address:
  • Phone: 412-996-2917
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberSP009121
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: