Provider Demographics
NPI:1982683207
Name:COONEY, MARINA JEAN (MD)
Entity Type:Individual
Prefix:
First Name:MARINA
Middle Name:JEAN
Last Name:COONEY
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 1:130 S BRYN MAWR AVE
Mailing Address - Street 2:BRYN MAWR HOSPITAL PSYCHIATRIC UNIT
Mailing Address - City:BRYN MAWR
Mailing Address - State:PA
Mailing Address - Zip Code:19010-3121
Mailing Address - Country:US
Mailing Address - Phone:484-337-4286
Mailing Address - Fax:484-337-4293
Practice Address - Street 1:130 S BRYN MAWR AVE
Practice Address - Street 2:BRYN MAWR HOSPITAL PSYCHIATRIC UNIT
Practice Address - City:BRYN MAWR
Practice Address - State:PA
Practice Address - Zip Code:19010-3121
Practice Address - Country:US
Practice Address - Phone:484-337-4286
Practice Address - Fax:484-337-4293
Is Sole Proprietor?:No
Enumeration Date:2006-01-13
Last Update Date:2012-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD054029L2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA232359401OtherMAIN LINE HEALTHCARE
PA0015419540005Medicaid
PA232359401OtherMAIN LINE HEALTHCARE
PA0015419540005Medicaid