Provider Demographics
NPI:1154517704
Name:JUSTINE MARUT SCHOBER MD
Entity type:Organization
Organization Name:JUSTINE MARUT SCHOBER MD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JUSTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHOBER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:814-455-5900
Mailing Address - Street 1:333 STATE ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16507-1450
Mailing Address - Country:US
Mailing Address - Phone:814-455-5900
Mailing Address - Fax:814-456-0667
Practice Address - Street 1:333 STATE ST
Practice Address - Street 2:SUITE 201
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16507-1450
Practice Address - Country:US
Practice Address - Phone:814-455-5900
Practice Address - Fax:814-456-0667
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JUSTINE MARUT SCHOBER MD
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-09-18
Last Update Date:2007-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD030163E291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0014615120003Medicaid