Provider Demographics
NPI:1316971815
Name:PLEASANT VALLEY FAMILY MEDICINE P.C.
Entity type:Organization
Organization Name:PLEASANT VALLEY FAMILY MEDICINE P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARY
Authorized Official - Middle Name:E
Authorized Official - Last Name:PIERGALLINI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:570-748-7400
Mailing Address - Street 1:401 HIGH ST
Mailing Address - Street 2:
Mailing Address - City:LOCK HAVEN
Mailing Address - State:PA
Mailing Address - Zip Code:17745-3013
Mailing Address - Country:US
Mailing Address - Phone:570-748-7400
Mailing Address - Fax:570-748-8004
Practice Address - Street 1:401 HIGH ST
Practice Address - Street 2:
Practice Address - City:LOCK HAVEN
Practice Address - State:PA
Practice Address - Zip Code:17745-3013
Practice Address - Country:US
Practice Address - Phone:570-748-7400
Practice Address - Fax:570-748-8004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-10
Last Update Date:2022-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0019525750001Medicaid
F40839Medicare UPIN