Provider Demographics
NPI:1992479265
Name:ROONEY, MARY E (PA-C)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:E
Last Name:ROONEY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:E
Other - Last Name:PETRO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:300 STATE ST STE 205
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16507-1429
Mailing Address - Country:US
Mailing Address - Phone:814-456-6022
Mailing Address - Fax:814-554-7314
Practice Address - Street 1:300 STATE ST STE 205
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16507-1429
Practice Address - Country:US
Practice Address - Phone:814-456-6022
Practice Address - Fax:814-455-4731
Is Sole Proprietor?:No
Enumeration Date:2021-08-02
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOA005740363A00000X
PAMA062701363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant