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General NPI Number Information
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NPI Number | 1851971824
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Entity Type | Individual
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Provider Name | MARA KIRSTIMEL LI GASANG BANEZ MD
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Gender | Female
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Dates
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Enumeration Date | 04/13/2021
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Last Update Date | 04/25/2024
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Provider Practice Location Address
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Address Line | 4800 FRIENDSHIP AVE
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City | PITTSBURGH
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State | PA
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Zip | 15224-1793
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Country | US
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Telephone | 412-359-8109
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Fax |
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Provider Business Mailing Address
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Address Line | 4800 FRIENDSHIP AVE
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City | PITTSBURGH
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State | PA
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Zip | 15224-1722
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Country | US
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Telephone | 412-359-8109
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 57.251488
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 207RR0500X
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Taxonomy Name | Rheumatology Physician
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License Number | MT230190
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License Number State | PA
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