Provider Demographics
NPI:1104087980
Name:WARGO-DORSEY, MARI ELIZABETH (DPM)
Entity type:Individual
Prefix:
First Name:MARI
Middle Name:ELIZABETH
Last Name:WARGO-DORSEY
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9218 ROUTE 119 HWY S
Mailing Address - Street 2:
Mailing Address - City:BLAIRSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15717-8849
Mailing Address - Country:US
Mailing Address - Phone:724-762-7621
Mailing Address - Fax:
Practice Address - Street 1:9218 ROUTE 119 HWY S
Practice Address - Street 2:
Practice Address - City:BLAIRSVILLE
Practice Address - State:PA
Practice Address - Zip Code:15717-8849
Practice Address - Country:US
Practice Address - Phone:724-762-7621
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-24
Last Update Date:2020-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC006043213ES0131X, 213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201202900Medicaid
KY7100256970Medicaid
KY50053192OtherPASSPORT HEALTH PLAN
KY000000834637OtherANTHEM
KY50053192OtherPASSPORT HEALTH PLAN
KYK107980Medicare PIN