Provider Demographics
NPI:1053371823
Name:ALLIAS, MARY C (PA-C)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:C
Last Name:ALLIAS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 N 4TH ST
Mailing Address - Street 2:
Mailing Address - City:YOUNGWOOD
Mailing Address - State:PA
Mailing Address - Zip Code:15697-1559
Mailing Address - Country:US
Mailing Address - Phone:724-925-1211
Mailing Address - Fax:724-925-2931
Practice Address - Street 1:505 N 4TH ST
Practice Address - Street 2:
Practice Address - City:YOUNGWOOD
Practice Address - State:PA
Practice Address - Zip Code:15697-1559
Practice Address - Country:US
Practice Address - Phone:724-925-1211
Practice Address - Fax:724-925-2931
Is Sole Proprietor?:No
Enumeration Date:2006-03-25
Last Update Date:2025-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA051025363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
078221Medicare ID - Type Unspecified
P84936Medicare UPIN