Provider Demographics
NPI:1558414979
Name:PHINNEY, MARYANN BUCKLEY (MD)
Entity Type:Individual
Prefix:DR
First Name:MARYANN
Middle Name:BUCKLEY
Last Name:PHINNEY
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 1:6645 UPPER YORK ROAD
Mailing Address - Street 2:#543
Mailing Address - City:SOLEBURY
Mailing Address - State:PA
Mailing Address - Zip Code:18963
Mailing Address - Country:US
Mailing Address - Phone:267-293-0495
Mailing Address - Fax:
Practice Address - Street 1:PENNSWOOD VILLAGE
Practice Address - Street 2:1382 NEWTOWN-LANGHORNE ROAD
Practice Address - City:NEWTOWN
Practice Address - State:PA
Practice Address - Zip Code:18940
Practice Address - Country:US
Practice Address - Phone:215-504-6809
Practice Address - Fax:215-579-0266
Is Sole Proprietor?:No
Enumeration Date:2007-01-19
Last Update Date:2016-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD450286207R00000X
NJ25MA08098200208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJP00688310-MERCEROtherRAILROAD MEDICARE
NJ0162281Medicaid
NJ0162281Medicaid