Provider Demographics
NPI:1487829628
Name:SMAY, MARISA ANN (PA-C)
Entity type:Individual
Prefix:MRS
First Name:MARISA
Middle Name:ANN
Last Name:SMAY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:MARISA
Other - Middle Name:ANN
Other - Last Name:BLOUGH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:600 SOMERSET AVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:WINDBER
Mailing Address - State:PA
Mailing Address - Zip Code:15963-1331
Mailing Address - Country:US
Mailing Address - Phone:814-467-0777
Mailing Address - Fax:
Practice Address - Street 1:600 SOMERSET AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:WINDBER
Practice Address - State:PA
Practice Address - Zip Code:15963-1331
Practice Address - Country:US
Practice Address - Phone:814-467-0777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-29
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA053000363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant