Basic Information
| Provider Information | |||||||||
| NPI: | 1225025430 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CIENCIVA | ||||||||
| FirstName: | ROSEMARIA | ||||||||
| MiddleName: | JUDITH | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 316 W THERESIA RD | ||||||||
| Address2: | |||||||||
| City: | ST MARYS | ||||||||
| State: | PA | ||||||||
| PostalCode: | 158572626 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8147816758 | ||||||||
| FaxNumber: | 8148341038 | ||||||||
| Practice Location | |||||||||
| Address1: | ERPG KEYSTONE MEDICAL ASSOCIATES | ||||||||
| Address2: | 136 STATE STREET | ||||||||
| City: | SAINT MARYS | ||||||||
| State: | PA | ||||||||
| PostalCode: | 158571626 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8147816758 | ||||||||
| FaxNumber: | 8148341038 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/03/2005 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | MD022377E | PA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 0008758290001 | 05 | PA | MEDICAID |