Provider Demographics
NPI:1447291620
Name:SZADA, MARYJO ELLEN (MD)
Entity type:Individual
Prefix:
First Name:MARYJO
Middle Name:ELLEN
Last Name:SZADA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:381 S FRONT ST
Mailing Address - Street 2:
Mailing Address - City:STEELTON
Mailing Address - State:PA
Mailing Address - Zip Code:17113-2529
Mailing Address - Country:US
Mailing Address - Phone:717-986-0794
Mailing Address - Fax:717-986-1094
Practice Address - Street 1:381 S FRONT ST
Practice Address - Street 2:
Practice Address - City:STEELTON
Practice Address - State:PA
Practice Address - Zip Code:17113-2529
Practice Address - Country:US
Practice Address - Phone:717-986-0794
Practice Address - Fax:717-986-1094
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-09
Last Update Date:2009-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD052118L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0014414300001Medicaid
F73212Medicare UPIN
PA0014414300001Medicaid