Organization
MARY LOUISE DECKER MD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARY LOUISE DECKER MD (OWNER)
(570) 822-6036
Entity
Organization
Contact information
Practice address
107 LOOMIS ST, WILKES BARRE, PA 18702-4637
(570) 822-6036
Mailing address
107 LOOMIS ST, WILKES BARRE, PA 18702-4637
(570) 822-6036
Taxonomy
Speciality
Code
Description
License number
State
207RI0200X
Infectious Disease Physician
Primary
MD065216L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1017052180001
—
PA
Enumeration date
01/16/2007
Last updated
08/22/2020
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