Provider Demographics
NPI:1891762977
Name:CARRIER-KINSLEY, MARIE (MD)
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:
Last Name:CARRIER-KINSLEY
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 1:261 OLD YORK RD
Mailing Address - Street 2:SUITE 620
Mailing Address - City:JENKINTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19046-3706
Mailing Address - Country:US
Mailing Address - Phone:215-885-8700
Mailing Address - Fax:215-885-8795
Practice Address - Street 1:261 OLD YORK RD
Practice Address - Street 2:SUITE 620
Practice Address - City:JENKINTOWN
Practice Address - State:PA
Practice Address - Zip Code:19046-3706
Practice Address - Country:US
Practice Address - Phone:215-885-8700
Practice Address - Fax:215-885-8795
Is Sole Proprietor?:No
Enumeration Date:2006-03-07
Last Update Date:2011-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA001804124208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0018041240003Medicaid
H25797Medicare UPIN
PA042834Medicare ID - Type Unspecified