Provider Demographics
NPI:1942298930
Name:KURIEN, MARY (MD)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:KURIEN
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 1:614 N EASTON RD
Mailing Address - Street 2:
Mailing Address - City:GLENSIDE
Mailing Address - State:PA
Mailing Address - Zip Code:19038-4301
Mailing Address - Country:US
Mailing Address - Phone:215-884-9770
Mailing Address - Fax:215-884-6301
Practice Address - Street 1:614 N EASTON RD
Practice Address - Street 2:
Practice Address - City:GLENSIDE
Practice Address - State:PA
Practice Address - Zip Code:19038-4301
Practice Address - Country:US
Practice Address - Phone:215-884-9770
Practice Address - Fax:215-884-6301
Is Sole Proprietor?:No
Enumeration Date:2005-10-12
Last Update Date:2012-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD4178942084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0019081560001Medicaid
H66665Medicare UPIN
059902Medicare ID - Type Unspecified