Provider Demographics
NPI:1619577954
Name:BROUGH, MARY CLAIRE
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:CLAIRE
Last Name:BROUGH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:252 W MAIN ST APT 1
Mailing Address - Street 2:
Mailing Address - City:MONONGAHELA
Mailing Address - State:PA
Mailing Address - Zip Code:15063-2443
Mailing Address - Country:US
Mailing Address - Phone:724-413-6574
Mailing Address - Fax:
Practice Address - Street 1:252 W MAIN ST APT 1
Practice Address - Street 2:
Practice Address - City:MONONGAHELA
Practice Address - State:PA
Practice Address - Zip Code:15063-2443
Practice Address - Country:US
Practice Address - Phone:724-413-6574
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-27
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175M00000XOther Service ProvidersMidwife, LayGroup - Single Specialty