=====================================================
General NPI Number Information
=====================================================
NPI Number | 1760453740
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARILYN JEAN OBIECUNAS RD, CDE, LDN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/30/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2027 LEBANON CHURCH RD
-----------------------------------------------------
City | WEST MIFFLIN
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15122-2461
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 412-344-3776
-----------------------------------------------------
Fax | 412-344-3776
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8 POTOMAC AVE
-----------------------------------------------------
City | PITTSBURGH
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15220-3026
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 412-344-4964
-----------------------------------------------------
Fax | 412-344-3776
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 133V00000X
-----------------------------------------------------
Taxonomy Name | Registered Dietitian
-----------------------------------------------------
License Number | DN001366
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------