Provider Demographics
NPI:1528004710
Name:BRINSFIELD, MARTHA LYNN (MD)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:LYNN
Last Name:BRINSFIELD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MARTHA
Other - Middle Name:LYNN
Other - Last Name:WHITE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:402 MCFARLAN ROAD
Mailing Address - Street 2:
Mailing Address - City:KENNETT SQUARE
Mailing Address - State:PA
Mailing Address - Zip Code:19348-2453
Mailing Address - Country:US
Mailing Address - Phone:610-444-5678
Mailing Address - Fax:610-444-1738
Practice Address - Street 1:402 MCFARLAN ROAD
Practice Address - Street 2:
Practice Address - City:KENNETT SQUARE
Practice Address - State:PA
Practice Address - Zip Code:19348-2453
Practice Address - Country:US
Practice Address - Phone:610-444-5678
Practice Address - Fax:610-444-1738
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2012-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD067694L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0017545500001Medicaid
PA027621Medicare PIN
G94433Medicare UPIN