Individual
MARY LOUISE SUSAN DECKER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
501 S WASHINGTON AVE STE 1000, SCRANTON, PA 18505-3814
(570) 941-0630
Mailing address
250 PIERCE ST STE 203, KINGSTON, PA 18704-5149
(570) 714-2524
(570) 714-2531
Taxonomy
Speciality
Code
Description
License number
State
207RI0200X
Infectious Disease Physician
Primary
MD065216L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0016925830001
—
PA
01
—
101303
UNISON HEALTH PLAN
PA
01
—
24497
GEISINGER HEALTH PLAN
PA
01
—
276915
HIGHMARK BLUE SHIELD
PA
01
—
806176
FIRST PRIORITY HEALTH
PA
Enumeration date
05/06/2006
Last updated
12/11/2020
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