Basic Information
| Provider Information | |||||||||
| NPI: | 1558654376 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GIOIA | ||||||||
| FirstName: | MARIA | ||||||||
| MiddleName: | D | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | DO | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | BALESTRINO | ||||||||
| OtherFirstName: | MARIA | ||||||||
| OtherMiddleName: | D | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | DO | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 333 ALLEGHENY AVE STE 101 | ||||||||
| Address2: | |||||||||
| City: | OAKMONT | ||||||||
| State: | PA | ||||||||
| PostalCode: | 151392072 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4124231048 | ||||||||
| FaxNumber: | 4128287580 | ||||||||
| Practice Location | |||||||||
| Address1: | 333 ALLEGHENY AVE STE 101 | ||||||||
| Address2: | |||||||||
| City: | OAKMONT | ||||||||
| State: | PA | ||||||||
| PostalCode: | 151392072 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4124231048 | ||||||||
| FaxNumber: | 4128287580 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/26/2011 | ||||||||
| LastUpdateDate: | 10/05/2020 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 10/05/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | OS016897 | PA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 102951314 | 05 | PA | MEDICAID |