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Individual

MARA C MODZESKI

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
MD

Contact information

Practice address
132 ABIGAIL LN, PORT MATILDA, PA 16870-7153
(814) 272-5011
(814) 272-6531
Mailing address
100 N ACADEMY AVE, DANVILLE, PA 17822-4903
(570) 271-6144

Taxonomy

Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
58125
MN
207Y00000X
Otolaryngology Physician
Primary
MD464929
PA

Other

Enumeration date
05/31/2013
Last updated
09/01/2020
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