1518911411 NPI number — MARYANNE FREEMAN BRNDJAR DO

Table of content: MARYANNE FREEMAN BRNDJAR DO (NPI 1518911411)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518911411 NPI number — MARYANNE FREEMAN BRNDJAR DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FREEMAN BRNDJAR
Provider First Name:
MARYANNE
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DO
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1518911411
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/28/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4 W MAIN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MACUNGIE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18062-1120
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-965-6200
Provider Business Mailing Address Fax Number:
610-965-6211

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4 W MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MACUNGIE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18062-1120
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-965-6200
Provider Business Practice Location Address Fax Number:
610-965-6211
Provider Enumeration Date:
05/22/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X , with the licence number:  OS008332L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 043696299 . This is a "CIGNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 043696299 . This is a "VALLEY PREFERRED" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 043969299 . This is a "AMERIHEALTH ADMINISTRATOR" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1537175 . This is a "HIGHMARK BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 3357346 . This is a "AETNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 043696299 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 20009508 . This is a "AMERIHEALTH MERCY" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0016012750003 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0135273000 . This is a "KEYSTONE EAST" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 043969299 . This is a "EPHN" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 043696299 . This is a "CHOICE PLUS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 50027457 . This is a "CAPITAL BLUE CROSS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 50027457 . This is a "KEYSTONE HEALTH CENTRAL" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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