Provider Demographics
NPI:1508885153
Name:DEVINE, MARY ANN (MD)
Entity Type:Individual
Prefix:
First Name:MARY ANN
Middle Name:
Last Name:DEVINE
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:PO BOX 8500-8721
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19178-0001
Mailing Address - Country:US
Mailing Address - Phone:973-734-0188
Mailing Address - Fax:973-290-7495
Practice Address - Street 1:1401 WHITEHORSE MERCERVILLE RD
Practice Address - Street 2:SUITE 212
Practice Address - City:HAMILTON
Practice Address - State:NJ
Practice Address - Zip Code:08619-3835
Practice Address - Country:US
Practice Address - Phone:609-588-5081
Practice Address - Fax:609-588-5086
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2016-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD050359L207RC0200X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA101138584-02OtherAMERICHOICE FRANKFORD
PA34937OtherHEALTH PARTNERS BUCKS
PAP00286205OtherRAILROAD MEDICARE
PA101138584-01OtherAMERICHOICE TORRESDALE
PA101138584-02OtherAMERICHOICE BUCKS
PA1011385840003Medicaid
PA34935OtherHEALTH PARTNERS TORRES
PA1011385840002Medicaid
PA1850152OtherUNITED HEALTHCARE
PA1128277OtherCIGNA
PA2334986000OtherKEYSTONE IBC
PA34936OtherHEALTH PARTNERS FRANK
PA1011385840001Medicaid
PA30024403OtherKEYSTONE MERCY
PA1658650OtherHIGHMARK BLUE SHIELD
PA1658650OtherPERSONAL CHOICE
PA1658650OtherPERSONAL CHOICE
PA1850152OtherUNITED HEALTHCARE