Healthcare Provider Details

I. General information

NPI: 1154655694
Provider Name (Legal Business Name): MERRIE DOROTHEA COUSINS D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/01/2009
Last Update Date: 06/04/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

603 WASHINGTON RD STE 300
PITTSBURGH PA
15228
US

IV. Provider business mailing address

11279 PERRY HWY STE 450
WEXFORD PA
15090-9303
US

V. Phone/Fax

Practice location:
  • Phone: 412-563-6151
  • Fax: 412-344-3780
Mailing address:
  • Phone: 724-933-1100
  • Fax: 724-933-1160

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberOS017474
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: