Provider Demographics
NPI:1518989888
Name:BRISLIN, MARIE (MD)
Entity Type:Individual
Prefix:DR
First Name:MARIE
Middle Name:
Last Name:BRISLIN
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 1:2600 W 9TH ST
Mailing Address - Street 2:2 NORTH
Mailing Address - City:CHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19013-2040
Mailing Address - Country:US
Mailing Address - Phone:610-485-3800
Mailing Address - Fax:610-485-4221
Practice Address - Street 1:744 E LINCOLN HWY
Practice Address - Street 2:110
Practice Address - City:COATESVILLE
Practice Address - State:PA
Practice Address - Zip Code:19320-3590
Practice Address - Country:US
Practice Address - Phone:610-380-4660
Practice Address - Fax:610-380-4664
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2011-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS-006887-L208000000X
DEC2-0007391208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001276031Medicaid
PA001276031Medicaid
PA711784Medicare ID - Type Unspecified