MEDICARE: BRIA MARIE TINSLEY MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	MD429420	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1306878178
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRIA MARIE TINSLEY MD

Provider Business Mailing Address
First Line	:	307 THIRD AVE.
Second Line	:
City	:	JESSUP
State	:	PA
Zip	:	18434
Country	:	US
Telephone Number	:	570-383-7922
Fax Number	:	570-383-5450

Provider Business Practice Location Address
First Line	:	407 THIRD AVE
Second Line	:
City	:	JESSUP
State	:	PA
Zip	:	18434-1415
Country	:	US
Telephone Number	:	570-383-7922
Fax Number	:	570-383-5450

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/06/2006
Last Update Date	:	02/03/2011

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