Provider Demographics
NPI:1033304043
Name:MARY ANNE FREEMAN BRNDJAR DO
Entity Type:Organization
Organization Name:MARY ANNE FREEMAN BRNDJAR DO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:MARY ANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:FREEMAN BRNDJAR
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:610-820-0300
Mailing Address - Street 1:1251 S CEDAR CREST BLVD
Mailing Address - Street 2:SUITE 109
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18103-6205
Mailing Address - Country:US
Mailing Address - Phone:610-820-0300
Mailing Address - Fax:610-820-5754
Practice Address - Street 1:1251 S CEDAR CREST BLVD
Practice Address - Street 2:SUITE 109
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18103-6205
Practice Address - Country:US
Practice Address - Phone:610-820-0300
Practice Address - Fax:610-820-5754
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-12
Last Update Date:2007-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS008332L207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
2229018000OtherKEYSTONE EAST
20027867OtherAMERIHEALTH MERCY
3357346OtherAETNA
50027453OtherCAPITAL BLUE CROSS
50027453OtherCAPITAL BLUE CROSS