Healthcare Provider Details

I. General information

NPI: 1760453740
Provider Name (Legal Business Name): MARILYN JEAN OBIECUNAS RD, CDE, LDN
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/30/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2027 LEBANON CHURCH RD
WEST MIFFLIN PA
15122-2461
US

IV. Provider business mailing address

8 POTOMAC AVE
PITTSBURGH PA
15220-3026
US

V. Phone/Fax

Practice location:
  • Phone: 412-344-3776
  • Fax: 412-344-3776
Mailing address:
  • Phone: 412-344-4964
  • Fax: 412-344-3776

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDN001366
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: