Healthcare Provider Details

I. General information

NPI: 1073563144
Provider Name (Legal Business Name): MARY ANNE POPE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2006
Last Update Date: 03/01/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 CHAFFEE ST
UNIONTOWN PA
15401-4605
US

IV. Provider business mailing address

100 NEW SALEM RD SUITE 116
UNIONTOWN PA
15401-8936
US

V. Phone/Fax

Practice location:
  • Phone: 724-434-5437
  • Fax: 724-437-2761
Mailing address:
  • Phone: 724-437-0729
  • Fax: 724-437-2761

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberMD-040126-L
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier0011061020007
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer
# 2
Identifier510873
Identifier TypeOTHER
Identifier State
Identifier IssuerHIGHMARK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: