Provider Demographics
NPI:1689636144
Name:BARNICLE, MARY ANNE (MD)
Entity Type:Individual
Prefix:
First Name:MARY ANNE
Middle Name:
Last Name:BARNICLE
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 1:1265 WAYNE AVE.
Mailing Address - Street 2:SUITE 208
Mailing Address - City:INDIANA
Mailing Address - State:PA
Mailing Address - Zip Code:15701-2776
Mailing Address - Country:US
Mailing Address - Phone:724-463-8850
Mailing Address - Fax:724-463-7072
Practice Address - Street 1:1265 WAYNE AVE
Practice Address - Street 2:SUITE 208
Practice Address - City:INDIANA
Practice Address - State:PA
Practice Address - Zip Code:15701-2776
Practice Address - Country:US
Practice Address - Phone:724-463-8850
Practice Address - Fax:724-463-7072
Is Sole Proprietor?:No
Enumeration Date:2006-04-03
Last Update Date:2012-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD038816E207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PW1769333OtherHIGHMARK BC BS
PA0014015970003Medicaid
PA078917OtherHIGHMARK BCBS
PA0014015970003Medicaid
PW1769333OtherHIGHMARK BC BS