Provider Demographics
NPI:1265449623
Name:BRAUNSTEIN, MARY JANE EMILY (MD)
Entity Type:Individual
Prefix:
First Name:MARY JANE
Middle Name:EMILY
Last Name:BRAUNSTEIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 E UNIVERSITY AVE
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78626-6814
Mailing Address - Country:US
Mailing Address - Phone:512-454-5721
Mailing Address - Fax:
Practice Address - Street 1:11111 RESEARCH BLVD
Practice Address - Street 2:SUITE 230
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-5264
Practice Address - Country:US
Practice Address - Phone:512-795-4620
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2021-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ6347207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX170195502Medicaid
TX8J9153OtherBCBS
TX8L4768Medicare PIN
TXG55892Medicare UPIN