Provider Demographics
NPI:1902972292
Name:MARTIN-PISARCIK, RUTH D (MD)
Entity Type:Individual
Prefix:
First Name:RUTH
Middle Name:D
Last Name:MARTIN-PISARCIK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:RUTH
Other - Middle Name:D
Other - Last Name:MARTIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:311 N SECOND ST
Mailing Address - Street 2:
Mailing Address - City:APOLLO
Mailing Address - State:PA
Mailing Address - Zip Code:15613-1330
Mailing Address - Country:US
Mailing Address - Phone:724-478-3766
Mailing Address - Fax:724-478-3767
Practice Address - Street 1:311 N SECOND ST
Practice Address - Street 2:
Practice Address - City:APOLLO
Practice Address - State:PA
Practice Address - Zip Code:15613-1330
Practice Address - Country:US
Practice Address - Phone:724-478-3766
Practice Address - Fax:724-478-3767
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-28
Last Update Date:2011-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD019904E207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA00657104Medicaid
PA00657104Medicaid
D75916Medicare UPIN