| Mario J. Sebastianelli, Md Pc | |
|
1416 Monroe Ave Ste 206 Dunmore PA 18509-2477 | |
| (570) 347-5212 | |
| (570) 346-4814 |
| Full Name | Mario J. Sebastianelli, Md Pc |
|---|---|
| Speciality | Internal Medicine |
| Location | 1416 Monroe Ave, Dunmore, Pennsylvania |
| Authorized Official Name and Position | Mario J. Sebastianelli (OWNER) |
| Authorized Official Contact | 5703475212 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mario J. Sebastianelli, Md Pc 1416 Monroe Ave Ste 206 Dunmore PA 18509-2477 Ph: (570) 347-5212 | Mario J. Sebastianelli, Md Pc 1416 Monroe Ave Ste 206 Dunmore PA 18509-2477 Ph: (570) 347-5212 |
| NPI Number | 1194723007 |
|---|---|
| Provider Enumeration Date | 07/13/2005 |
| Last Update Date | 08/06/2007 |
| Medicare PECOS PAC ID | 9739167651 |
|---|---|
| Medicare Enrollment ID | O20040708000651 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1194723007 | NPI | - | NPPES |
| 0669080 | Medicaid | PA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | MD006983E (Pennsylvania) | Secondary |
| 207RN0300X | Internal Medicine - Nephrology | MD006983E (Pennsylvania) | Primary |
| Provider Name | Mario J Sebastianelli |
|---|---|
| Provider Type | Practitioner - Nephrology |
| Provider Identifiers | NPI Number: 1972501872 PECOS PAC ID: 2860522810 Enrollment ID: I20100617000613 |
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