Provider Demographics
NPI:1073180899
Name:PRITZ, MARY KATHALEEN ELIZABETH (PA-C)
Entity type:Individual
Prefix:
First Name:MARY KATHALEEN
Middle Name:ELIZABETH
Last Name:PRITZ
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4815 LIBERTY AVE STE M54
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15224-2156
Mailing Address - Country:US
Mailing Address - Phone:412-621-1818
Mailing Address - Fax:412-621-4337
Practice Address - Street 1:4815 LIBERTY AVE STE M54
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15224-2156
Practice Address - Country:US
Practice Address - Phone:412-621-1818
Practice Address - Fax:412-621-4337
Is Sole Proprietor?:No
Enumeration Date:2021-06-09
Last Update Date:2021-09-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMA062454363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAMA062454OtherPENNSYLVANIA STATE BOARD OF MEDICINE LICENSE NUMBER